_________________________________ 

Fire Fighter Fatality Investigation 

and Prevention Program: 

Findings from a 

National Evaluation 

Kristina Peterson 

Michael Witt 

Katherine Morton 

Murrey Olmsted 

RTI International 

and 

Harlan E. Amandus

 Steven L. Proudfoot 

James T. Wassell 

N ational Institute for Occupational Safety and Health (NIOSH) 

Division of Safety Research 

Morgantown, WV 26505 

RTI International is a trade name of Research Triangle Institute. 
ABSTRACT 

Firefighters are called on to rescue people and protect property under serious and 

hazardous conditions. Some 100 firefighters die each year on duty, and another 

80,000 are injured. Recommendations developed through the National Institute for 

Occupational Safety and Health’s (NIOSH’s) Fire Fighter Fatality Investigation and 

Prevention Program (FFFIPP) point to a number of safety practices that could improve the 

health and safety of the nation’s firefighters. 

The purpose of this document is to summarize the findings of an evaluation of the 

FFFIPP. The goals of the evaluation were to assess the effects of FFFIPP recommendations 

on fire department policies and procedures and to identify possible strategies for improving 

the impact of the FFFIPP. The evaluation is based on a national survey of fire departments 

together with a series of focus groups with frontline firefighters. 

Key findings from the evaluation are that (1) small, volunteer departments have the 

greatest challenges to following safety guidelines; (2) existing resources limit safety 

practices; (3) gaps in knowledge and attitudes limit safety; (4) FFFIPP reports provide 

useful information but fire departments need additional information and in additional 

formats; (5) FFFIPP materials need to be better marketed and distributed; and (6) 

increasing awareness of FFFIPP investigations likely will improve safety practices. 

Key Terms 

firefighter; fire department; evaluation; establishment survey; focus groups; 

occupational safety and health; dissemination; research to practice 

ii 
FFFIPP Evaluation 

Contents 

Section Page 

Abstract ii
 

Introduction 1
 

Fire Department Survey 3
 

Firefighter Focus Groups 6
 

Findings: Awareness of the FFFIPP 7
 

Findings: Implementation of FFFIPP Recommendations 14
 

Findings: Barriers and Facilitators 27
 

Findings: Recommended Changes to Content and Format of NIOSH 

Recommendations 32
 

Implications and Recommendations 37
 

References 44
 

Appendix A. Sentinel Recommendations for the FFFIPP Evaluation 46
 

Appendix B. Definitions of the Stratification Variables 47
 

Appendix C. Fire Department Survey: Sample Sizes, Eligibility Rates, and 

Response Rates 48
 

Appendix D. Fire Department Questionnaire 49
 

Appendix E. Statistical Methodology 50
 

Appendix F. Characteristics of Focus Group Participants 57
 

iii 
FFFIPP Evaluation 

Tables 

Number Page 

1.	 Acronyms Used in the Report ........................................................................... 3
 

2.	 Percentage of Fire Departments Who Have Safety Elements and Who 

Experienced a Fatality and FFFIPP Investigation.................................................31
 

iv 
FFFIPP Evaluation 

Figures 

Number Page 

1.	 How Familiar Are You With the FFFIPP? (Question 9), by Fatality and FFFIPP 

Investigation (Percent)...................................................................................10
 

2.	 How Often Have You Seen NIOSH Reports That Describe Recent Firefighter 

Fatalities and Make Recommendations for Avoiding Similar Incidents? 

(Question 43), by Jurisdiction Type (Percent) ....................................................11
 

3.	 How Does Your Department Receive the NIOSH Firefighter Fatality 

Investigation Reports? (Question 44), by Size of Jurisdiction (Percent)..................11
 

4.	 Have You Read Part or All of a NIOSH Firefighter Fatality Investigation Report
 

in the Last 12 Months? (Question 45), by Size of Jurisdiction (Percent) .................12
 

5.	 What Other NIOSH Materials Have You Seen? (Question 53), by Size of
 

Jurisdiction (Percent) .....................................................................................13
 

6.	 Does the Fire Department Disseminate the Information It Receives from 

NIOSH to the Firefighters? (Question 50), by Size of Jurisdiction (Percent) ............13
 

7.	 How Is This Information Disseminated to Firefighters? (Question 50a), by Size 

of Jurisdiction (Percent)..................................................................................14
 

8.	 For Which of the Following Does Your Department Have SOPs/SOGs in Place? 

(Question 3, Part 1), by Type of Department (Percent) .......................................18
 

9.	 For Which of the Following Does Your Department Have SOPs/SOGs in Place? 

(Question 3, Part 2), by Type of Department (Percent) .......................................18
 

10.	 Required Training (Questions 4a-c), by Jurisdiction Type (Percent) .......................19
 

11.	 In What Ways Has Your Department Used NIOSH Recommendations? 

(Question 11), by Size of Jurisdiction (Percent)..................................................20
 

12.	 About How Often Do You Think Your Firefighters Use Their Seat Belts When 

Riding in the Emergency Vehicles? (Question 18), by Size of Jurisdiction 

(Percent) .....................................................................................................21
 

13.	 How Often Is Incident Command Established When Responding to Structure 

Fires? (Question 21), by Size of Jurisdiction (Percent).........................................22
 

14.	 About How Often Does an Incident Commander Assign an Incident Safety 

Officer When Responding to Structure Fires? (Question 24), by Size of
 

Jurisdiction (Percent) .....................................................................................23
 

15.	 How Often Are RITs Available at Structure Fires? (Question 26), by
 

Jurisdiction Type (Percent)..............................................................................24
 

16.	 Does Your Fire Department Have Enough PASS Devices for All Firefighters for 

Use When Fighting Structure Fires? (Question 29), by Fatality and FFFIPP 

Investigation (Percent)...................................................................................25
 

17.	 Do Your Firefighters Ever Have to Share Face Pieces for SCBAs? (Question 

33), by Size of Jurisdiction (Percent) ................................................................26
 

v 
INTRODUCTION 

The purpose of this document is to summarize 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. NIOSH also conducts some research for prevention of 

nonfatal injuries. The goals of the program are to 

	 better define the magnitude and characteristics of line-of-duty deaths among 

firefighters, 

	 develop recommendations for the prevention of deaths and injuries, and 

	 disseminate prevention strategies to the fire service (Centers for Disease Control 

and Prevention [CDC], 2006). 

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. There have been 21 mailings, at least one each 

year of the program, beginning with one in 1998 to five in 1999 and two, most recently, in 2007. 

Summaries of the NIOSH reports are also published in fire service trade journals. 

FFFIPP does not enforce compliance with safety and health standards and does not 

determine fault or blame. As a research and dissemination program, its aim is to learn from 

the events and prevent future similar events (CDC, 2006). 

The purpose of this evaluation was to 

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

department policies and procedures to improve firefighter safety and health; 

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 

1 
FFFIPP Evaluation 

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. Broadly speaking, 

these two components address the following five questions: 

	 Are firefighters aware of the NIOSH FFFIPP program and reports? 

	 To what extent are FFFIPP recommendations being implemented in the nation’s fire 

departments and how are FFFIPP recommendations being implemented? 

	 What factors, if any, hinder fire departments’ ability to implement FFFIPP 

recommendations? 

	 What characteristics of fire departments facilitate their adherence to FFFIPP 

recommendations? 

	 What changes are appropriate, if any, in the content or format of recommendations 

developed by NIOSH? 

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 (NIOSH, 2004). 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 overall balance among the categories of safety recommendations. 

The sentinel recommendations are listed in Appendix A. The evaluation focused on the 

impacts of these recommendations in firefighter training, standard operating procedures 

(SOPs), safety practices, and the safety environment of the fire departments. 

These elements of the evaluation methodology were developed in consultation with 

NIOSH and a number of stakeholders from the fire service. Stakeholder organizations that 

provided advice and consultation during the evaluation include the National Fire Protection 

Association (NFPA), the National Volunteer Fire Council (NVFC), the United States Fire 

Administration (USFA), the International Association of Fire Chiefs (IAFC), and the Fire 

Department Safety Officers Association (FDSOA).1 

The following sections provide details about the methodology used to collect data for 

this evaluation. Common acronyms used in this report are defined in Table 1. 

1

 The International Association of Fire Fighters (IAFF) was also invited to provide input. 

2 
FFFIPP Evaluation 

Table 1. Acronyms Used in the Report 

Acronym Definition 

AED automated external defibrillators 

CDC Centers for Disease Control and Prevention 

CVD cardiovascular disease 

FFFIPP Fire Fighter Fatality Investigation and Prevention Program 

ISO incident safety officer 

IC Incident Command System 

LODD Line of Duty Death Report 

NIOSH National Institute for Occupational Safety and Health 

PASS devices personal alert safety system devices 

PPE personal protective equipment 

RIC rapid intervention crew 

RIT rapid intervention team 

SCBA self-contained breathing apparatus 

SOG standard operating guideline 

SOP standard operating procedure 

FIRE DEPARTMENT SURVEY 

Sample Design 

The Fire Department Survey used a cross-sectional design with stratified random 

sampling. We selected a probability sample of 3,000 fire departments representing 

10 percent of the approximately 30,000 fire departments in the United States. The sampling 

frame came from a database maintained by NFPA,2

 supplemented with information from 

NIOSH’s Division of Safety Research. The sample includes 

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

December 31, 2003; 

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

had occurred but no FFFIPP investigation had been conducted; 

	 the 10 largest fire departments, based on the size of the population served in the

 jurisdiction, because of their unique status; and 

2

 There were 30,611 departments on the NFPA list, of which 30,308 are involved with fire suppression. 

3 
FFFIPP Evaluation 

	 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 goal of the sampling design was to help determine factors that influence the 

extent to which FFFIPP recommendations are implemented by the departments. In 

particular, the sample is designed to determine the impact of firefighter fatality 

investigations and previous firefighter fatalities on fire department implementation of NIOSH 

recommendations. Four of the five high-priority strata were selected with certainty for the 

sample selection. These are (1) previous firefighter fatality investigation following a 

traumatic injury fatality, (2) previous firefighter fatality investigation following a Cardiovascular 

Disease(CVD) fatality, (3) traumatic injury fatality but no firefighter fatality investigation, and 

(4) the 10 largest fire departments.3

 All fire departments on the sample frame that are categorized 

into one of these four groups were selected for the Fire Department Survey sample. 

The fifth high priority stratum consists of those fire departments that had a CVD 

fatality but no FFFIPP investigation. It was considered a noncertainty stratum because some 

fire departments on the sample frame that fall within this stratum were not selected. There 

are 189 fire departments in this stratum on the sample frame. We selected 95 (50 percent) of these 

departments to provide a stratum sample size commensurate with the other high-priority 

strata. Because three of the high-priority strata are certainty strata and the fifth high-priority stratum 

had a sample selected at a rate of 50 percent; the resulting variance of any comparison estimates 

was expected to be small enough for credible data analyses. 

Factors that previous studies have shown to influence fire department practices 

include geographic location, department type (career and volunteer), department size, and 

population density.4

 A representative sample of subpopulations defined by each of these is 

included as additional strata in the sample design. The additional strata were defined by the 

interaction of the following variables: 

	 Census region (Northeast, South, Midwest, and West) 

	 department type (volunteer, career, or combination) 

3

 The 10 departments are the California Department of Forestry, Los Angeles City Fire Department, 

Los Angeles County Fire Department, Miami-Dade Fire-Rescue, Houston Fire Department, Chicago 

Fire Department, New York City Fire Department, Arkansas Forestry Commission, San Bernardino 

County Fire Department, and Philadelphia Fire Department. 

4

 See, for example, Fahy, 2005, 2006; Karter, 2005; and Fahy and LeBlanc, 2006. 

4 
FFFIPP Evaluation 

 jurisdiction size (size of population served: large, medium, or small) 

 jurisdiction type (population density: rural versus urban) 

The definitions of these variables are provided in Appendix B. Within each of these 

noncertainty strata, the sample of fire departments was selected randomly and with equal 

probability. 

The final sample for the survey is described in Appendix C. 

Development of the Questionnaire 

Items for the Fire Department Survey questionnaire address the key questions about 

the impact of the FFFIPP as related to the sentinel FFFIPP recommendations. Performance 

indicators for the impact of FFFIPP recommendations concern changes in the knowledge, 

behavior, attitudes, and safety practices at the management level. Questionnaire items 

related to safety practices focus on 

 SOPs (or standard operating guidelines [SOGs]), 

 standard performance requirements, 

 content and timing of training offered to firefighters, 

 communication of safety practices and standards, and 

 investment in and maintenance of firefighter safety equipment. 

The questionnaire is provided in Appendix D. 

Implementation and Analysis Approach 

The Fire Department Survey was mailed to the Fire Chiefs of the 3,000 sample fire 

departments during spring 2006. The overall response rate for the survey was 54.9 percent. 

Statistical analysis weights were developed to enable the estimation of population 

parameters. A nonresponse follow-up analysis was conducted to assess any nonresponse 

bias. The results suggest that nonresponse bias may exist for at least some of the response 

options in the Fire Department Survey. 

The analytic approach to the survey data was developed in collaboration with NIOSH. 

The analysis is primarily descriptive and exploratory. First, we examined the findings about 

the key evaluation questions across all fire departments. For each question, we then 

conducted bivariate analyses to investigate whether there are systematic differences that 

can be attributed to specific fire department characteristics (region, type of jurisdiction, size 

of department, and type of department), experience with FFFIPP investigations, and 

5 
FFFIPP Evaluation 

firefighter fatalities. The overall differences between types of fire departments were tested 

for statistical significance (using a standard t-test). Details about the statistical methodology 

are provided in Appendix E. The null hypothesis for these tests is that the difference 

between population estimates among two groups of fire departments is zero. All population 

estimates generated from the Fire Department Survey data also have accompanying 

estimates of standard errors and confidence intervals. The complete statistical tables are 

available upon request to NIOSH. 

Because most fire departments are small, volunteer departments, we also estimated 

responses to these same questions at the firefighter level of analysis using information 

supplied in the questionnaire on the number of firefighters in each department. 

To examine the combined explanatory effects of region, jurisdiction type, jurisdiction 

size, department type, and experience with a FFFIPP investigation and fatality, multivariate 

logistic regression models are also examined using the fire department–level data. 

Throughout the analysis, information from the Fire Department Survey is 

supplemented with available information derived from the focus groups. The methodology 

used to collect focus group data is discussed below. 

FIREFIGHTER FOCUS GROUPS 

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

collect additional information. The focus groups with frontline firefighters captured aspects 

of the FFFIPP’s influence that could not be fully assessed in a survey of fire department 

officers; information collected through the focus groups thus contributed to a greater 

understanding of how the FFFIPP influences fire departments and their officers and 

firefighters. The primary objectives of the focus groups were to 

	 identify the impact of the FFFIPP on the knowledge of firefighters, 

	 identify the impact of the FFFIPP on fire department operations (on, for example, 

the content of training, SOPs, and SOGs), 

	 identify the impact of the FFFIPP on fire safety practices, and 

	 explore how the organizational climate of fire departments contributes to the 

overall safety environment in which firefighters work. 

The focus groups also contributed information about the barriers and facilitators that 

influence the impact of FFFIPP recommendations. 

6 
FFFIPP Evaluation 

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. 

Participants for the focus groups were selected using a targeted, convenience 

sampling approach. The composition of these focus groups was designed to reflect the 

primary groupings represented in the Fire Department Survey design. Every effort was 

made to recruit participants who represented the various kinds of fire department 

characteristics, including size (small, medium, large), type of department (career, 

volunteer), and type of jurisdiction (urban, rural). Although the participants represented a 

wide cross section of firefighters, they are not a random probability sample of all 

firefighters. 

The six groups included one focus group consisting of all volunteer firefighters, one 

focus group consisting of all career firefighters, and four focus groups consisting of a mix of 

career and volunteer firefighters. Details on the characteristics of the focus group 

participants are provided in Appendix F. 

The focus groups yielded a rich store of qualitative data on the problems and safety 

concerns of firefighters. Using simple thematic analysis techniques (Miles & Huberman, 

1994), we compiled a list of the major themes in the focus group participant responses to 

questions about the safety climate, dissemination of safety recommendations, and impact of 

the FFFIPP on firefighter safety. 

The following section summarizes the principal findings from the evaluation. 

FINDINGS: AWARENESS OF THE FFFIPP 

Summary 

The picture that emerges from the evaluation suggests that the FFFIPP is only 

moderately known within the fire service. Although most fire department officers 

(67.4 percent) are familiar with NIOSH, only about half (53.3 percent) have seen and read a 

FFFIPP report in the prior 12 months. Slightly more than half (54.3 percent) are not familiar 

with the FFFIPP suggesting that more officers are familiar with the reports than the FFFIPP itself. 

Fire department officers learn about FFFIPP recommendations primarily through NIOSH 

mailings, trade publications, Web sites, and other firefighters and fire departments. 

NIOSH recommendations have been used by fire departments to 

7 
FFFIPP Evaluation 

	 update the content of their training programs (40.2 percent of all study-eligible 

fire departments in the country, or about 11,000 departments), 

	 update their SOPs/SOGs (34.9 percent of the fire departments), 

	 develop new SOPs/SOGs (26.3 percent), and 

	 justify grant applications (15.5 percent). 

For example, fire departments report using NIOSH recommendations to train 

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

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

traffic hazards, radio communications, and other topics. NIOSH recommendations have also 

been used to justify current budget/staffing, and to make new budget requests (5.0 percent 

and 5.5 percent of fire departments, respectively). 

To raise awareness of the NIOSH recommendations, fire departments—in addition to 

training their firefighters—also post information from NIOSH on fire station bulletin boards 

and brief firefighters about the recommendations during regular staff meetings. About twofifths (38.9 percent) of fire departments, however, say they do not disseminate information 

from NIOSH to frontline firefighters. 

Multivariate analyses show that the size of the jurisdiction is the most consistent 

predictor of dissemination activities. When all other factors in the model are controlled, size 

of jurisdiction remains a significant explanatory factor: The larger the jurisdiction, the more 

likely it is that FFFIPP recommendations are disseminated throughout the fire department. 

The type of department (career, volunteer, or combination) and region of the country are 

seldom or never significant factors in the dissemination process once size of jurisdiction is 

taken into account. However, jurisdiction type (urban, rural) remains a significant factor for 

determining whether the fire chief is familiar with NIOSH reports, has read the Line of Duty 

Death (LODD) reports, or has read the Pocket Guide, and whether firefighters are trained on 

NIOSH recommendations. Officers in urban fire departments are more likely to be aware of 

and to make use of FFFIPP recommendations than other departments. A fire chief in a 

department that had a FFFIPP investigation is more likely to have read LODD reports, even 

after controlling for other factors in a multivariate analysis. 

Details 

An overview of the response patterns related to firefighters’ awareness of the FFFIPP 

recommendations is provided below. Results are presented for each question in the survey 

8 
FFFIPP Evaluation 

that addressed the level of awareness of the FFFIPP. The source of the information is 

indicated in parentheses in each subject heading. 

Awareness of NIOSH (Q8)5 

Most fire department officers (67.4 percent) are somewhat or very familiar with 

NIOSH.6

 The percentage of officers who are somewhat or very familiar with NIOSH tends to 

be lowest in the Midwest (61.1 percent) or West (64.0 percent), in small jurisdictions 

(60.6 percent), and in departments with a mixture of career and volunteer staff 

(64.7 percent). 

Awareness of the FFFIPP (Q9) 

Over half (54.3 percent) of all fire department officers are not at all or not very 

familiar with the FFFIPP. The highest percentage of officers who are not at all or not very 

familiar with the FFIPP are found in the Midwest (59.3 percent) and West (49.8 percent), in 

rural areas (56.5 percent), and in volunteer (54.0 percent) and mixed volunteer-career fire 

departments (51.3 percent). 

Among fire departments with a prior fatality, most (81.6 percent) of the officers in 

departments that had a FFFIPP investigation are “somewhat familiar” or “very familiar” with 

the FFFIPP (Figure 1). Note that the small percentage (6.8 percent) of the officers in fire 

departments with a prior fatality who were "not familiar" with the FFFIPP may not have been 

working at the fire department at the time a FFFIPP investigation took place. 

How Do Fire Department Officers Learn about FFFIPP Recommendations? (Q10) 

Fire departments learn about FFFIPP recommendations through a variety of sources. 

In order of frequency, these are NIOSH mailings (67.8 percent of all fire departments), 

trade publications (47.2 percent), links from Web sites such as NFPA and Firehouse 

(28.2 percent), the NIOSH Web site (24.3 percent), other firefighters or fire departments 

(22.9 percent), seminars or other training opportunities (16.4 percent), media reports 

(14.9 percent), state conferences (11.5 percent), national conferences (3.6 percent), and 

other (1.1 percent). 

5 Q = Question Item number in the Fire Department Survey. See Appendix A for the wording of the

 question. 

6 All percentages in this report are based on weighted data. 

9 
FFFIPP Evaluation 

Figure 1. How Familiar Are You With the FFFIPP? (Question 9), by Fatality and 

FFFIPP Investigation (Percent) 

6.8 

11.7 

38.7 42.9 

9.5 

22.9 

51.0 

16.5 

21.0 

33.8 37.8 

7.5 

0 

20 

40 

60 

80 

100 

Not at all familiar Not very familiar Somewhat familiar Very familiar 

Fatality with Investigation Fatality without Investigation No Fatality 

Familiarity with FFFIPP Line of Duty Death Reports (Q43) 

About two-fifths of the fire department officers (38.9 percent) report seeing FFFIPP 

reports several times per year or more. A quarter (26.8 percent) say they have never seen 

a FFFIPP report (Figure 2). The percentage of officers who have never seen a FFFIPP report 

is highest among rural (27.6 percent), volunteer (23.5 percent), and a mixture of volunteer 

and career (29.45) fire departments. 

How FFFIPP Reports Are Obtained (Q44) 

Fire department officers receive LODD reports primarily through NIOSH mailings. 

However, although NIOSH periodically sends FFFIPP reports to every fire department in the 

country, only 56 percent of the respondents to the Fire Department Survey reported 

receiving FFFIPP reports from NIOSH via mail. About one-fourth (24.7 percent) of fire 

department officers report that they download FFFIPP reports from the Internet, 10 percent 

get them from colleagues in other departments, and 6.9 percent obtain FFFIPP reports at 

conferences and other meetings (Figure 3). 

Do Fire Department Officers Read FFFIPP Reports? (Q45) 

Over half (53.3 percent) of all fire department officers have read a FFFIPP report 

within the previous 12 months. The percentage of officers who have not read a FFFIPP 

report during the past 12 months is highest among medium (18.1 percent) and small 

departments (21.3 percent) (Figure 4). 

10 
FFFIPP Evaluation 

Figure 2.	 How Often Have You Seen NIOSH Reports That Describe Recent 

Firefighter Fatalities and Make Recommendations for Avoiding Similar 

Incidents? (Question 43), by Jurisdiction Type (Percent) 

27.6 

35.3 32.1 

5.1 

12.7 

33.9 

47.2 

6.2 

0 

20 

40 

60 

80 

100 

Never One or two times per 

year 

Several times per 

year 

Once a month or 

more 

Rural Urban 

Figure 3.	 How Does Your Department Receive the NIOSH Firefighter Fatality 

Investigation Reports? (Question 44), by Size of Jurisdiction 

(Percent) 

55.1 

63.4 

18.6 22.5 

56.7 

35.8 

11.4 8.6 

55.7 

18.2 

8.9 5.6 

0 

20 

40 

60 

80 

100 

By mail On the Internet Colleagues in other 

departments 

Conferences or other 

meetings 

Large Medium Small 

11 
FFFIPP Evaluation 

Figure 4.	 Have You Read Part or All of a NIOSH Firefighter Fatality 

Investigation Report in the Last 12 Months? (Question 45), by Size of 

Jurisdiction (Percent) 

83.7 

9.1 

65.5 

18.1 

46.8 

21.3 

0 

20 

40 

60 

80 

100 

Yes No 

Large Medium Small 

Other NIOSH Reports Received (Q53) 

The majority of fire department officers (57.4 percent) report that they have seen 

NIOSH’s Pocket Guide to Chemical Hazards. However, only 31.7 percent have seen an Alert, 

and 28.0 percent have seen a FFFIPP CD-ROM (28.0 percent). Relatively few have seen a 

Hazard IDs (16.6 percent), Respirator Maintenance Program Guide (13.8 percent), or 

Workplace Solutions (12.5 percent). A quarter of fire department officers (25.2 percent) 

report they have not seen any NIOSH materials (Figure 5). The percentage that has not 

seen any NIOSH material is highest among small (30.3 percent), rural (25.4 percent), 

volunteer (25.0 percent), and a mixture of volunteer and career (26.2 percent) fire 

departments. 

Do Fire Departments Disseminate FFFIPP Recommendations to Firefighters? (Q50) 

The majority of officers (60.7 percent) report that their fire department disseminates 

information it receives from NIOSH to their firefighters. About two-thirds of all firefighters 

(67.6 percent) work in departments where FFFIPP information is disseminated to firefighters 

(Figure 6). 

12 
FFFIPP Evaluation 

Figure 5. What Other NIOSH Materials Have You Seen? (Question 53), by Size 

of Jurisdiction (Percent) 

100 

80 

60 

40 

20 

0 

85.2 

26.3 

41.2 

62.9 

23.9

17.1 

5.5 

64.8 

18 

30.1

41.3 

17.7

15.7

15.9 

52.9 

11.3 

26.5

26

15.8

10.8 

30.3 

Pocket Guide to Respirator CDs of firefighter Alerts Hazard IDs Workplace None 

Chemical Hazards Maintenance program materials Solutions 

Program Guide 

Large Medium Small 

Figure 6.	 Does the Fire Department Disseminate the Information It Receives 

from NIOSH to the Firefighters? (Question 50), by Size of Jurisdiction 

(Percent) 

79.8 

12.9 

71.1 

12.2 

55.2 

12.0 

0 

20 

40 

60 

80 

100 

Yes No 

Large Medium Small 

How Is the Information Disseminated within the Department? (Q50a, Focus 

Groups) 

Information is disseminated to the firefighters primarily through training 

(44.2 percent of all departments), posting the FFFIPP report on the station bulletin board 

(38.5 percent), and briefings during regular staff meetings (23.5 percent). Other 

approaches fire departments use include providing copies to firefighters (16.2 percent), 

providing firefighters with NIOSH’s summaries of reports (6.2 percent), sending e-mail 

13 
FFFIPP Evaluation 

messages to firefighters (5.3 percent), providing summaries of reports prepared by the fire 

department (1.8 percent), and posting the FFFIPP report on the fire department’s Web site 

(1.3 percent) (Figure 7). 

Figure 7.	 How Is This Information Disseminated to Firefighters? (Question 

50a), by Size of Jurisdiction (Percent) 

100 

57.7 

80 

37.7 

48.7 

48.1 

41.7 

60 

27.0 

32.6 

8.8

8.5 

7.0 

34.7 

23.9 

24.9 

10.2

2.2

1.8

9.2 

23.2 

11.6

4.3

1.4 

34.2 

0.6

2.4 

20 

40 

0 

Regular staff 

meetings 

Training 

sessions 

Copies of NIOSH 

reports 

NIOSH report 

summaries 

Department's 

summaries 

Large Medium Small 

Postings on 

bulletin boards 

Post on the 

department 

website 

Email to 

firefighters 

In the focus group discussions, frontline firefighters suggested all of these can be 

effective approaches for communicating safety messages. Two training officers explained 

how they use FFFIPP LODD reports for training: 

We use the information from NIOSH all the time for training. I hand out different 

LODDs and then require the trainees to answer six questions about the incident and 

to make a presentation to the full class. It’s a valuable tool for training. 

I look over the history of firefighter deaths, based on the LODDs, and use PowerPoint 

slides to tell the class about lessons learned. 

FINDINGS: IMPLEMENTATION OF FFFIPP RECOMMENDATIONS 

Summary 

To assess how FFFIPP recommendations are being implemented, we collected 

information from the fire departments on 

 the existence of personnel responsible for safety and training in the department 

(i.e., a training officer and safety officer), 

 the SOPs that fire departments have established to reinforce safe practices, 

 the nature of the training fire departments provide their firefighters, and 

14 
FFFIPP Evaluation 

	 other ways departments have implemented FFFIPP recommendations. 

We found that most fire departments have both a training officer and a safety officer 

and that most have SOPs on five of the six types of recommendations addressed in this 

evaluation: PPE and clothing, radio communications, Incident Command Systems, motor 

vehicle safety, PASS devices, and maintenance of SCBA.7

 Few fire departments have SOPs 

on fitness and wellness. 

The majority of fire departments in the country also require firefighters to be trained 

on five of the six types of recommendations addressed in this evaluation: using PPE 

(88.9 percent), fighting structure fires (82.8 percent), driving safety (77.7 percent), using 

radio communication devices (76.2 percent), using the Incident Command System 

(69.9 percent), and maintaining SCBA (60.3 percent). However, only 7 percent of the fire 

departments have a required physical fitness training program, and most (60.9 percent) fire 

departments do not require firefighters to be screened for CVD risk factors and CVD. 

Most fire departments (84.0 percent) ensure that firefighters responsible for driving 

emergency vehicles receive driver training before being allowed to operate the vehicles. 

However, in focus group discussions, frontline firefighters said they need to be trained to 

the class of the vehicle and that home responders need additional training. Most fire 

departments (84.2 percent) require their firefighters to wear seat belts while in emergency 

vehicles, although 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 (88 percent) 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” (77.0 percent). Firefighters in almost all fire departments 

(89.8 percent) reportedly use their SCBA at least “most of the time” while 

fighting structure fires. Many fire departments (49.7 percent), however, say that 

their firefighters still have to share facepieces. 

7

 The six categories of Sentinel Recommendations are Incident Command, motor vehicle safety, 

equipment, radio communication, safety on the fireground, and fitness/wellness. Several discrete 

recommendations are included under each of these categories. 

15 
FFFIPP Evaluation 

	 have automated external defibrillators (AEDs) (77.4 percent) and perform routine 

maintenance on the AEDs. The AEDs are usually kept on the emergency vehicles 

(82.4 percent), at the fire station (3.7 percent), or both (13.8 percent). 

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

structure fires at least “most of the time” (91.0 percent). 

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

(84.2 percent) fire departments on a routine basis when responding to structure fires. 

However, focus group participants identified the failure to implement Incident Command as 

one of their most common safety concerns. 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 (91.0 percent), monitor location 

of all firefighters at the scene (76.2 percent), and develop and initiate a risk management 

plan (52.3 percent). Incident Commanders in only about half of all fire departments 

(52.1 percent) usually assign an Incident Safety Officer (ISO). 

The size of the fire department’s jurisdiction is the most consistent predictor of its 

safety practices. When all other factors are controlled for, the larger the jurisdiction, the 

more likely it is that the FFFIPP has had an impact on fire departments and firefighters. The 

multivariate models also indicate that the type of department (career, volunteer, or 

combination) and jurisdiction type (urban or rural) are seldom significant factors regarding 

the impact of the FFFIPP. A notable exception is the provision of a physical fitness program. 

Even controlling for other factors in the model, urban and career fire departments are more 

likely than other departments to have either optional or required physical fitness programs. 

In addition, fire departments in the Northeast and West are more likely than those in other 

regions to have been affected by the FFFIPP. Finally, fire departments that have 

experienced a fatality are more likely to have made changes to their training programs and 

their existing SOPs based on NIOSH recommendations. Fire departments that have 

experience with a FFFIPP investigation are more likely to have developed new SOPs and 

used NIOSH recommendations for justifying grant applications. 

Details 

A summary of the bivariate response patterns related to the implementation of 

FFFIPP recommendations is provided below for each question in the survey that relates to 

this issue. 

16 
FFFIPP Evaluation 

Safety Officers (Q1) 

More than two-thirds of fire departments (70.3 percent) have a safety officer. 

Training Officer (Q2) 

Almost all fire departments (88.5 percent) have a training officer. 

Standard Operating Procedures (Q3) 

SOPs, or SOGs, are common management tools for fire departments. NIOSH 

recommends that fire departments “develop and implement a policy requiring the use of 

Personal Protective Equipment and protective clothing” and “implement an Incident 

Command System with written SOPs for all firefighters.” We found that most fire 

departments have SOPs on five of the six types of recommendations addressed in this 

evaluation: PPE and clothing (89.1 percent of all departments), radio communications 

(84.8 percent), Incident Command Systems (83.7 percent), motor vehicle safety 

(78.8 percent), PASS devices (75.4 percent), and maintenance of SCBA (69.7 percent). Few 

fire departments have SOPs on fitness and wellness. Only 16.8 percent of fire departments 

have an SOP for participating in regular CVD screenings, and only 11.0 percent have an SOP 

for participating in a personal physical fitness program (Figures 8 and 9). The percentage 

of fire departments with SOPs for personal physical fitness programs was lowest in 

volunteer (14.1 percent) and combination volunteer-career (6.4 percent), Southern 

(9.3 percent), and rural (8.4 percent) fire departments. 

Training (Q4) 

The great majority of fire departments in the United States require firefighters to be 

trained on using PPE (88.9 percent), fighting structure fires (82.8 percent), driving safety 

(77.7 percent), using radio communication devices (76.2 percent), using the Incident 

Command System (69.9 percent), and maintaining SCBA (60.3 percent) (Figure 10). 

Fewer departments (35.5 percent) require training in rapid intervention teams (RITs). 

Training Providers (Q5) 

Firefighter training is provided by a variety of people. Over three-quarters of the fire 

departments provide training through their training officer (84.9 percent), other officers in 

the department (82.8 percent), and the state fire training academy (77.4 percent). 

17 
FFFIPP Evaluation 

Figure 8.	 For Which of the Following Does Your Department Have SOPs/SOGs 

in Place? (Question 3, Part 1), by Type of Department (Percent) 

100 91.5 

84.8 82.5 83.3 81.4 79.3 78.2 

80 72.6 

67.1
 

60
 47.8 

42.9
 

40
 

17.7 

20 14.1 14.2 

6.4
 

0
 

Incident Command Maintenance of Motor vehicle safety Physical fitness Regular CVD 

Systems SCBAs program screenings 

Career Volunteer Combination 

Figure 9. For Which of the Following Does Your Department Have SOPs/SOGs 

in Place? (Question 3, Part 2), by Type of Department (Percent) 

70.4 

83.0 

94.1 

88.1 

45.6 

74.6 

89.1 85.0 

35.1 

75.1 

88.7 84.4 

0 

20 

40 

60 

80 

100 

Rapid Intervention 

Teams 

Use of PASS devices Use of PPE Radio 

communications 

Career Volunteer Combination 

18 
FFFIPP Evaluation 

Figure 10. Required Training (Questions 4a-c), by Jurisdiction Type (Percent) 

100 93.4 93.8 

88.2 90.2 89.3 

81.7 83.8 

77.5 76.7 77.0 80 68.8 

60.6 57.9 

60
 

40
 31.0 

20 

0 

Fighting Driving safety Incident Maintenance of Rapid Use of PPE Use of radio 

structure fires Command SCBAs Intervention communication 

Systems Teams 

Rural Urban 

Use of NIOSH Recommendations (Q11, 11A, 11B) 

Among those who have seen information about NIOSH’s recommendations, the most 

common use of the recommendations is to modify the content of the firefighter training 

program (40.2 percent) and to change departmental SOPs (34.9 percent). Over one-third of 

all fire departments have made these changes as a result of the NIOSH recommendations. 

Other common applications of NIOSH recommendations are new SOPs (26.3 percent) and 

grant applications (15.5 percent). The most common topics of NIOSH recommendations that 

are used for training programs are PPE and clothing (41.6 percent), SCBA (40.1 percent), 

PASS systems (32.6 percent), Incident Command Systems (32.1 percent), traffic hazards 

(29.3 percent), and radio communications (23.0 percent). The greatest use of NIOSH 

recommendations for training is among fire departments in large jurisdictions, particularly 

training on PPE and SCBA (Figure 11). 

19 
FFFIPP Evaluation 

Figure 11.	 In What Ways Has Your Department Used NIOSH Recommendations? 

(Question 11), by Size of Jurisdiction (Percent) 64.9 47.4 67.3 16.3 16.6

27.7 

50.1 

35.3

47.8 

7.9

9.7 

20.5 

34.5

21.3

27.6 

3.2

3.1

12.7 

0 

20 

40 

60 

80 

100 

Changes to 

SOPs/SOGs 

Current 

budget/staffing 

New 

budget/staffing 

requests 

Grant applications 

Large Medium Small 

Changes to New SOPs/SOGs 

training program 

Department Fitness Training Program (Q12) 

NIOSH recommends that fire departments make fitness/wellness programs 

mandatory for their firefighters. The vast majority (78.5 percent) of fire departments in the 

United States do not have a fitness training program for their firefighters, however. Only 

two-fifths (41.2 percent) of firefighters work in fire departments that have a fitness training 

program (either optional or required). 

Cardiovascular Disease Screenings (Q13) 

NIOSH recommends that fire departments conduct medical evaluations to screen 

firefighters for CVD risk factors and CVD. Well over half (60.9 percent) of all fire 

departments, however, still do not require these screenings. Only 17.1 percent require 

annual screenings; 14.5 percent screen only at the time of employment. 

Driver Training (Q14, 15, Focus Groups) 

NIOSH recommends that fire departments “ensure all drivers of fire department 

vehicles receive driver training at least twice a year and document the training.” According 

to the Fire Department Survey, most firefighters (93.6 percent) responsible for driving 

emergency vehicles receive driver training before being allowed to operate the vehicles. 

Firefighters in about half of all fire departments (54.5 percent) also receive refresher driver 

training once or more a year. However, during the focus group discussions, firefighters said 

there is a need for better driver training. They said that firefighters need to be trained to 

the class of the vehicle, especially drivers of water tankers. Volunteer firefighters—the home 

responders—should also be trained. 

20 
FFFIPP Evaluation 

Seat Belt Requirement (Q16) 

NIOSH recommends that fire departments “ensure that all firefighters riding in 

emergency fire apparatus are wearing and are properly belted and secured by seat belts.” 

The findings from the Fire Department Survey indicate that the majority of fire departments 

(84.2 percent) require their firefighters to wear seat belts while they are in emergency 

vehicles. 

Firefighters’ Use of Seat Belts (Q18) 

Firefighters in only about half (54.9 percent) of the nation’s fire departments are 

thought to use their seat belts “most of the time” or “always”; 5.4 percent never use seat 

belts and 22.7 percent use seat belts only some of the time (Figure 12.) 

Figure 12.	 About How Often Do You Think Your Firefighters Use Their Seat Belts 

When Riding in the Emergency Vehicles? (Question 18), by Size of 

Jurisdiction (Percent) 

1.1 

8.8 

49.3 

30.2 

2.6 

21.7 

15.1 

6.8 10.6 

37.1 

23.7 23.5

18.1 

38.6 

12.8 

0 

20 

40 

60 

80 

100 

Never Some of the time About half the time Most of the time Always 

Large Medium Small 

Establishing Incident Command (Q21, Focus Groups) 

NIOSH recommends that fire departments “establish and implement an Incident 

Command System with written SOPs for all firefighters.” In response to the question, “What 

is the worst safety incident that you have experienced in your career?” focus group 

participants identified a variety of safety problems. Among the most common was failure to 

implement Incident Command. Firefighters in four of the focus groups said there is “a lot of 

freelancing” rather than Incident Command. According to the Fire Department Survey, 

21 
FFFIPP Evaluation 

however, 84.2 percent responded that Incident Command is established “always” or “most 

of the time” when responding to structure fires (Figure 13). 

Figure 13. How Often Is Incident Command Established When Responding to 

Structure Fires? (Question 21), by Size of Jurisdiction (Percent) 

0.7 0.2 2.1 

9.5 

87.5 

0.4 3.2 2.8 3.1 

8.8 8.5 

31.0 

21.6 

72.1 

48.5 

0 

20 

40 

60 

80 

100 

Never Rarely About half the time Most of the time Always 

Large Medium Small 

Incident Commander’s Responsibilities (Q23) 

NIOSH recommends that fire departments ensure that the Incident Commander 

(1) “always maintains close accountability for all personnel at the fire scene,” (2) “conducts 

an initial size-up of the incident before initiating firefighting efforts,” and (3) ”continually 

evaluates the risk versus gain during operations at an incident.”8

 The tasks that fire 

departments say are part of an Incident Commander’s responsibilities are (in order of 

mention) to 

 develop and coordinate the fire attack strategy (93.1 percent of all departments); 

 conduct an initial assessment (Item 2 above; 91.0 percent); 

 monitor location of all firefighters at the scene (Item 1 above; 76.2 percent); 

 ensure that at least four firefighters are on the scene before entering the building 

(68.6 percent); 

 identify and implement a communication strategy (64.7 percent); 

8

 These are Sentinel Recommendations 1-2 and 1-3, respectively. See Attachment 1 for further 

details. 

22 
FFFIPP Evaluation 

 develop and initiate a risk management plan (Item 3 above; 52.3 percent); 

 establish a collapse zone around the building (49.1 percent); 

 establish an RIT or RIC (48.5 percent); and 

 document all assessments, plans, and events related to the fire (38.8 percent). 

Assigning ISO (Q24) 

NIOSH recommends that fire departments ensure that the Incident Commander 

appoints “a separate Incident Safety Officer, independent from the Incident Commander.” 

Incident Commanders in about half (52.1 percent) of all fire departments assign an ISO at 

least most of the time; 13.3 percent of fire departments never assign an ISO (Figure 14). 

Figure 14.	 About How Often Does an Incident Commander Assign an Incident 

Safety Officer When Responding to Structure Fires? (Question 24), by 

Size of Jurisdiction (Percent) 

3.3 

33.1 

6.6 

29.8 

7.8 8.6 

35.2 

16.2 

7.9 

27.2 24.3 24.1 27.2 27.5 

21.2 

0 

20 

40 

60 

80 

100 

Never Some of the time About half the time Most of the time Always 

Large Medium Small 

Use of RITs (Q26, Focus Groups) 

NIOSH recommends that fire departments “ensure that a Rapid Intervention Team is 

established and in position immediately upon arrival at a fire scene.” Firefighters in focus 

groups said that one of their main safety concerns is the failure to routinely (i.e., “most of 

the time” or “always”) use RITs. Firefighters explained that, with not enough personnel on 

the scene, they sometimes need to enter structures without the RITs in place. Across all fire 

departments, under half (42.4 percent) said they have RITs available at least most of the 

time. Almost two-thirds (60.6 percent) of all firefighters are in departments that routinely 

23 
FFFIPP Evaluation 

have RIT available at structure fires. Urban fire departments and departments in large 

jurisdictions are more likely to establish RITs than rural fire departments (Figure 15). 

Figure 15.	 How Often Are RITs Available at Structure Fires? (Question 26), by 

Jurisdiction Type (Percent) 

30.3 

24.8 

7.3 

22.2 

15.4 

9.2 

14.5 

5.3 

26.4 

44.7 

0 

20 

40 

60 

80 

100 

Never Some of the time About half the time Most of the time Always 

Rural Urban 

Availability of PASS Devices for All Firefighters (Q29) 

Only about three-quarters (78.8 percent) of all fire departments say they have 

enough PASS devices for all of their firefighters to use when fighting structure fires. 

However, 93.4 percent of fire departments that have experience with a FFFIPP investigation 

report having enough PASS devices (Figure 16). 

Use of PASS Devices (Q30) 

NIOSH recommends that fire departments “strictly enforce the wearing and use of 

PASS devices when firefighters are involved in fire fighting, rescue, and other hazardous 

duties.” Almost all (88.0 percent) fire departments report that their firefighters use their 

PASS devices at least most of the time. 

24 
FFFIPP Evaluation 

Figure 16.	 Does Your Fire Department Have Enough PASS Devices for All 

Firefighters for Use When Fighting Structure Fires? (Question 29), by 

Fatality and FFFIPP Investigation (Percent) 

93.4 

6.6 

81.3 

18.7 

78.6 

21.4 

0 

20 

40 

60 

80 

100 

Yes No 

Fatality with Investigation Fatality without Investigation No Fatality 

Availability of SCBA and Personalized Face pieces (Q32, 33) 

Almost all (99.2 percent) fire departments report that they have SCBA for their 

firefighters to use when they combat structure fires. About half (49.7 percent) of all fire 

departments, however, say that their firefighters have to share face pieces for SCBA. 

Sharing face pieces is more often required in the small fire departments (56.5 percent) than 

large fire departments (10.4 percent) (Figure 17). 

Use of SCBA (Q34) 

NIOSH recommends that fire departments “ensure that officers enforce and 

firefighters wear their SCBA whenever there is a chance they might be exposed to a toxic or 

oxygen-deficient atmosphere, including initial assessment.” Firefighters in almost all 

(89.8 percent) fire departments reportedly use SCBAs at least most of the time while 

fighting structure fires. 

Maintenance of SCBA (Q36) 

NIOSH recommends that fire departments “develop and implement a preventive 

maintenance program to ensure that all SCBA are adequately maintained. About threefourths (76.0 percent) of fire departments perform SCBA maintenance at least several times 

a year. Fewer than 5 percent perform maintenance “less than once a year” or “never.” 

25 
FFFIPP Evaluation 

Figure 17. Do Your Firefighters Ever Have to Share Face Pieces for SCBAs? 

(Question 33), by Size of Jurisdiction (Percent) 

10.4 

89.2 

37.4 

62.3 

56.5 

42.5 

0 

20 

40 

60 

80 

100 

Yes No 

Large Medium Small 

Availability of AEDs (Q38, 38a) 

About three-quarters (77.4 percent) of all fire departments have AEDs. Among fire 

departments that have AEDs, most keep their AEDs on the emergency vehicles 

(82.4 percent), at the fire station (3.7 percent), or in both locations (13.8 percent). About 

85 percent of firefighters are in departments that have AEDs available. 

Maintenance of AEDs (Q39) 

NIOSH recommends that fire departments perform routine maintenance on their 

AEDs by following “manufacturers’ instructions to replace battery packs immediately when 

the unit indicates a low battery or replace battery message.” Among fire departments that 

have AEDs, most (86.3 percent) report that they perform routine maintenance on AEDs 

between once a year and once a month or more, or “after every time they are used.” 

Two-Way Communication Devices (Q40, 41) 

NIOSH recommends that fire departments “ensure that firefighters who enter 

hazardous areas are equipped with two-way communications with incident command” and 

that the radio “does not bleed over, cause interference, or lose communication under field 

conditions.” Firefighters in almost all (91.0 percent) fire departments have radios or other 

two-way communication devices while they are responding to structure fires at least “most 

of the time.” Only 18 percent report that they “never” have problems under field conditions 

with these devices. 

26 
FFFIPP Evaluation 

FINDINGS: BARRIERS AND FACILITATORS 

The Fire Department Survey included a number of questions in which respondents 

could select from a list of possible reasons for not being able to implement a FFFIPPrecommended safety practice. The FFFIPP recommendations that are addressed in these 

questions concern the use of equipment— Self Contained Breathing Apparatus (SCBA), 

personally fitted SCBA face pieces, Personal Alert Safety System (PASS) devices, seat belts, and 

turnout gear generally—and procedures on the fireground, such as Incident Command, incident 

safety officers ISOs, and Rapid Intervention Teams (RITs). The response options included a number 

of factors that potentially make it difficult to follow safety guidelines, including funding, equipment, 

personnel, fire department practices, the situation on the fireground, and firefighter resistance. 

The Fire Department Survey also included questions about the extent to which funding is generally 

adequate for various purposes. These general questions about the adequacy of funding focused on 

equipment, training, and personnel. 

Additionally, survey responses were partitioned by whether fire departments had 

experienced a FFFIPP investigation. Thus, the impact of a FFFIPP investigation to facilitate 

compliance to safety recommendations is reviewed. 

To What Extent Do Limited Financial Resources Affect Fire 

Departments’ Ability to Implement FFFIPP Recommendations? 

(Q33a, 37a, 42a-c) 

The results of the Fire Department Survey suggest that a substantial portion of the 

nation’s fire departments do not have enough funding to purchase the equipment, training, 

and personnel needed to implement FFFIPP-recommended safety practices. 

	 Almost half of all departments (48.6 percent) say they do not have enough 

funding for equipment. (Q42a) 

	 One-third of the fire departments (31.8 percent) say they do not have enough 

funding for personally fitted SCBA face pieces for all of their firefighters. (Q33a) 

	 Two-fifths (39.1 percent) of all fire departments say they do not have enough 

funds for training. (Q42b) 

	 More than half of fire departments (51.5 percent) do not have enough funding for 

the personnel they need. (Q42c) 

27 
FFFIPP Evaluation 

To What Extent Do Fire Departments Have Enough (or Adequate) 

Personal Protective Gear for Their Firefighters? (Q17, 33a) 

The results of the Fire Department Survey suggest that a lack of equipment hinders 

some departments from implementing FFFIPP-recommended safety practices. Fire 

departments also report that problems with existing equipment can keep firefighters from 

following safety practices. 

	 Almost half (49.7 percent) say their firefighters have to share face pieces. (Q33) 

	 One-quarter of all fire departments (24.6 percent) do not have enough SCBA for 

all of their firefighters to use. (Q33a) 

	 One-quarter (24.9 percent) say their firefighters are not able to fit comfortably in 

their seat belts while wearing turnout gear in emergency vehicles. (Q17) 

	 One-fifth (21.2 percent) say they do not have enough PASS devices for all fire 

fighters when fighting structure fires (Q29) 

What Other Factors Limit Fire Departments’ Ability to Follow 

Recommended Safety Practices? (Q22, 25, 28, 31, 33a, 35, 37a) 

A number of additional barriers to implementing FFFIPP-recommended safety 

practices emerged from the Fire Department Survey. The most commonly cited barrier is 

insufficient personnel at the scene. More than half say this prevents them from assigning an 

ISO (51.7 percent) and establishing RITs (53.5 percent) (Q25 and Q28). One-fifth 

(21.2 percent) say it prevents them from establishing Incident Command (Q22). 

The second most common reason for not implementing a FFFIPP-recommended 

safety practice is the situation on the fireground: 

	 One-third of the departments (32.3 percent) say they sometimes do not assign 

an ISO because the fire is not large enough. (Q25) 

	 One-third of the departments (34.9 percent) do not establish RIT because the fire 

is not large enough. (Q28) 

	 One-quarter of the departments (25.9 percent) say their firefighters sometimes 

do not use SCBA because the situation does not require them. (Q35) 

	 One-fifth (22.5 percent) sometimes do not establish Incident Command because 

the fire is not big enough to require it. (Q22) 

	 About 9.5 percent say their firefighters sometimes do not use their PASS devices 

because the situation does not require them. (Q31) 

28 
FFFIPP Evaluation 

“Usual fire department practice” is cited as the reason that 

	 Almost one-quarter of fire departments (23.4 percent) say their firefighters do 

not use personally fitted face pieces for their SCBA (because “shared systems 

work fine for our needs”). (Q33a) 

	 About one-fifth (19.7 percent) do not have 

Chemical/Biological/Radiological/Nuclear (CBRN) SCBA (“We do not have enough 

technical information to purchase CBRN SCBAs”). (Q37a) 

Very few fire departments cite firefighter resistance as a reason a FFFIPPrecommended safety practice is not followed: 

	 Only 10.3 percent say firefighters do not think they need SCBA. (Q35) 

	 Only 4.6 percent say firefighters do not think they need PASS devices. (Q31) 

	 Less than 1.0 percent (0.3 percent) say firefighters do not like using the 

personally fitted SCBA face pieces. (Q33a) 

What Factors Help Promote Safe Practices? (Focus Groups) 

The results of the firefighter focus groups suggest that a number of circumstances 

encourage safe practices. 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. 

Experience with an On-Duty Firefighter Fatality 

Departments that have a prior fatality are less likely than other departments to 

identify personnel, equipment, or situational barriers to implementing FFFIPP-recommended 

safety practices. Data from the focus group discussions support these findings. Firefighters 

whose departments have experienced a line-of-duty death are aware of the FFFIPP and its 

impact on department policy: 

If there is a specific incident and it gets a lot of media attention, the impact can be 

huge and immediate. 

Experiencing a FFFIPP Investigation 

FFFIPP investigations appear to have had a significant impact on some departmental 

policies, training programs, and the availability of safety equipment. The Fire Department 

Survey results suggest that FFFIPP investigations may have had an impact on 

29 
FFFIPP Evaluation 

 changes in training programs regarding structure fires, driver safety, Incident 

Command, and RITs; 

 SOPs/SOGs on SCBA maintenance and the use of PASS devices; and 

 the availability of individual SCBA face pieces. 

Table 2 provides details about these impacts. The statistically significant results are 

indicated by the numbers in the superscripts in column 1. 

Data from the focus group discussions support these findings. For example, frontline 

firefighters whose departments have experienced a FFFIPP investigation told us the 

following: 

The LODD report affected a lot of our procedures. Both policies and practices were 

affected. 

We had a NIOSH investigation at my department, and it was really tough. They came 

in and they really reamed us. But afterwards, it was like we made 25 years of 

progress in a few months. We didn’t have an accountability system. The gear was 10 

years old and had never been cleaned. It really raised the Chief’s consciousness. 

Until then, we just got away with it. Then a light bulb went off. 

Another focus group participant noted the following: 

Having an independent agency conduct the investigation is important. Their brutal 

honesty when they come in is what helps.... It usually brings good change when it 

comes. 

Enforcement Mechanisms 

Firefighters indicated that the most effective ways to encourage safety practices are 

enforcement mechanisms tied to financial and other penalties. The focus group data suggest 

that financial and legal penalties, as well as their officer’s attention to specific safety issues, 

can have a significant impact on firefighter behavior. 

Several firefighters described the financial and legal penalties on fire departments 

that can motivate greater safety practices. Firefighters are aware that their actions can 

result in citations, lawsuits, and fines against the fire department: 

The department’s ISO rate is determined, in part, by its rating on the level of safety 

training provided. The ISO rate, in turn, affects insurance rates. 

30 
FFFIPP Evaluation 

Table 2.	 Percentage of Fire Departments Who Have Safety Elements and Who 

Experienced a Fatality and FFFIPP Investigationa 

1 2 3 

Fatality and Fatality and 

FFFIPP No FFFIPP 

Safety Element Investigation investigation No Fatality 

SOPs/SOGs (Q3)b in place for 

– SCBA maintenance 80.8%[2,3] 68.7% 69.6% 

– motor vehicle safety 90.3%[3] 82.7% 78.7% 

– personal physical fitness 24.3%[3] 18.1% 10.9% 

– RITs 64.0%[3] 55.5% 40.1% 

– use of PASS devices 83.2%[2,3] 71.5% 75.3% 

Required training (Q4) on 

– structure fires 90.4%[2,3] 76.3% 82.8% 

– driver safety 92.0%[2,3] 80.3% 77.6% 

– Incident Command 86.3%[2,3] 73.6% 69.7% 

– maintenance of SCBA 73.4%[3] 61.1% 60.2% 

– RITs 60.5%[2,3] 36.1% 35.4% 

Made changes to SOPs/SOGs (Q11) 66.2%[2,3] 51.3% 34.5% 

Made changes to training program 68.0% 56.3% 39.8% 

(Q11) 

Trained firefighters on physical fitness 28.8%[2,3] 16.3% 8.3% 

and CVD 

Provide annual CVD screening (Q13) 32.6% 24.4% 17.0% 

Use RITs at least most of the time 64.4%[3] 59.1% 42.0% 

(Q26) 

Have enough PASS devices (Q29) 93.4%[2,3] 81.3% 78.6% 

Always use PASS devices (Q30) 91.0%[2,3] 74.4% 75.1% 

Firefighters do not have to share 64.1%[2,3] 44.2% 49.4% 

SCBA face pieces (Q33) 

Always carry radios or other 2-way 82.5%[2,3] 66.6% 70.4% 

communication devices while 

responding to structure fires (Q40) 

CVD = cardiovascular disease; PASS = Personal Alert Safety System; RIT = rapid intervention 

team; SCBA = self-contained breathing apparatus; SOG = standard operating guideline; SOP = 

standard operating procedure. 

a

 The numbers in the square brackets indicate that the percentage estimate is significantly different at 

the 95 percent confidence interval from the corresponding estimate in the column identified (column 

2 or 3). The superscript [2], for example, indicates that, among departments that had experienced a 

firefighter fatality, the presence of the safety feature varies significantly depending on whether the 

fire department had experienced a FFFIPP investigation or not. The superscript [3] indicates that the 

presence of the safety feature varies significantly between fire departments that had experienced a 

fatality and a FFFIPP investigation and fire departments that had not experienced a fatality at all. 

b

 Text in parentheses refers to the question number in the Fire Department Survey 

31 
FFFIPP Evaluation 

Firefighters acknowledge that they take safety precautions more seriously if there 

are tangible personal penalties for ignoring them. The penalties that can be imposed on 

firefighters include days off without pay, denied promotions, demotions or loss of job, and 

loss of death benefits in the event of a line of duty death. 

Our chief makes us take days off without pay if the firefighter does not use a seat 

belt. That gets people’s attention. He’s also said that if you lose an eye because you 

failed to have your gear on properly, you will be fired. 

As these comments suggest, fire department officers play a key role in promoting 

safety. However, firefighters can receive mixed messages from their officers, as the 

following comment shows: 

Most of the awards for valor usually involve ... doing things you aren’t supposed to 

do. It’s in our nature to want to save someone. If nothing goes wrong despite 

ignoring the rule, you’ll be praised for saving someone. 

Firefighters also told us that union representation promotes safety. 

FINDINGS: RECOMMENDED CHANGES TO CONTENT AND 

FORMAT OF NIOSH RECOMMENDATIONS 

A number of questions were posed during the focus group discussions and in the Fire 

Department Survey about NIOSH’s current materials for disseminating the findings of the 

FFFIPP investigations. Firefighters say that learning about specific incidents helps them 

develop safer work practices, and they appreciate that the LODD reports are unbiased. 

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

add more visual aids to clarify the fire scene. Fire department officers want more 

straightforward and less generic recommendations. They also want help translating FFFIPP 

recommendations into ready-made training material and sample SOPs. 

The most common recommendation from firefighters is for improvements in the 

ways FFFIPP materials are disseminated and marketed. They recommend that NIOSH 

update the FFFIPP mailing list and e-mail listserv, implement procedures for refreshing 

these lists regularly, and better advertise the lists. 

Finally, firefighters suggest that NIOSH develop coordinated campaigns around 

specific issues to raise awareness throughout the fire service. They suggest that NIOSH 

prepare summary documents with statistics showing the number of deaths and injuries due 

to specific unsafe practices. 

32 
FFFIPP Evaluation 

Details about these issues follow. 

Does NIOSH Provide Useful and Practical Recommendations? (Q49, 

52A-C, Focus Groups) 

About two-thirds of the officers who are aware of the NIOSH reports indicate that 

they agree or strongly agree that NIOSH reports are practical (68.4 percent), easy to 

understand (69.5 percent), and specific and concrete (57.9 percent). The remaining third 

primarily expressed a neutral opinion about the reports (they neither agreed nor disagreed 

with these statements).9

 Many focus group participants said they valued the detailed, 

factual information provided in NIOSH’s LODD reports. Learning about specific incidents 

helped them develop safer work practices. 

Does NIOSH Present the Findings of FFFIPP Investigations in Ways 

That Are Accessible to Fire Department Staff? (Q47-49, 53A-54, 

Focus Groups) 

Officers and firefighters are very appreciative of the unbiased, factual information 

provided in the LODD reports and offer a number of suggestions for enhancing the 

information provided in them, including ideas about both formatting and content. 

Format of the LODD Reports (Focus Groups) 

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). 

Amount of Detail (Q47) and Length of Reports (Q48, Focus Groups) 

Among those officers who are familiar with the FFFIPP LODD reports, 88.2 percent 

rate the amount of detail in the reports as “about right.” The firefighters who participated in 

the focus groups are similarly satisfied with the length of the LODD reports. 

Both officers and frontline firefighters, however, suggest that more visual aids be 

added to the LODD reports to clarify the fire scene. The most common suggestions for 

enhancing the LODDs are adding 

 a graphic showing a timeline of events, 

9

 Very few officers suggested that they thought the recommendations were impractical (only 

1.2 percent of those who said they were aware of the reports), not easy to understand 

(3.0 percent), or not specific and concrete (5.0 percent). 

33 
FFFIPP Evaluation 

 a diagram of the fire scene (e.g., the floor plan), and 

 more photos. 

Several officers and firefighters also want more information about the victim(s) to 

heighten the impact of the recommendations. Other firefighters and officers want more 

technical detail about the scene and a broader scope of investigation. 

Satisfaction with Other NIOSH Materials (Q53, Q53a, Focus Groups) 

Besides the LODD reports, the only NIOSH item that most officers are aware of is the 

Pocket Guide to Chemical Hazards. A quarter of the officers (25.2 percent) say they have 

not seen any NIOSH materials other than LODD reports. In order of frequency, the overall 

proportion of officers who have seen additional NIOSH materials are as follows: 

 Pocket Guide to Chemical Hazards, 57.4 percent 

 Alerts, 31.7 percent 

 CDs of firefighter program materials, 28.0 percent 

 Hazard IDs, 16.6 percent 

 Respirator Maintenance Program Guide, 13.8 percent 

 Workplace Solutions, 12.5 percent 

Officers in about two-fifths of all fire departments (39.3 percent) that have seen 

other NIOSH materials report that they are satisfied or very satisfied with the additional 

materials. 

Firefighters who participated in the focus group discussions are less familiar with 

these materials than those who answered the survey. One focus group thought a different 

format would be more compelling for conveying lessons learned across a number of FFFIPP 

investigations. Their suggestion is to add statistics showing the number of deaths and 

injuries due to specific unsafe practices and to make use of communication techniques 

employed by the media. 

Visited the NIOSH Web Site? (Q54) 

The majority of officers responding to the Fire Department Survey (59.4 percent) 

have not visited the NIOSH Web site. 

34 
FFFIPP Evaluation 

How Can the Findings of FFFIPP Investigations Be Made More 

Useful? (Q49, Q56, Focus Groups) 

Fire department officers’ and firefighters’ responses offered a number of 

recommendations for improving the impact of the findings from FFFIPP investigations. The 

six most common are as follows. 

Improve Distribution Mechanisms and Marketing (259 suggestions) 

By far the most common recommendation from the fire department officers is for 

improvements in the ways FFFIPP materials are disseminated. Comments ranged from the 

broad “improve the marketing of the materials,” to specific suggestions about updated 

mailing lists. Some officers said they had not known about the materials and asked to be 

placed on the mailing list. The range of suggestions fell into the following categories: 

	 Mail materials directly to fire departments, especially smaller departments (71 

suggestions). 

	 Improve the marketing of the materials (61 suggestions). 

	 Develop and maintain updated e-mail listservs (60 suggestions). 

	 Improve distribution of reports (40 suggestions). 

	 Maintain an updated contact list of fire department recipients (27 suggestions). 

	 Communicate information to state and local agencies (7 suggestions). 

	 Mail materials directly to safety and training officers (4 suggestions). 

	 Create a banner with the NIOSH Web site address to post on fire station bulletin 

boards (1 suggestion). 

Firefighters want NIOSH to facilitate access to the FFFIPP information. Most of the 

frontline firefighters who participated in the focus groups are not familiar with the FFFIPP or 

FFFIPP information products. A recurring theme in the discussions was the value of FFFIPP’s 

investigations and the firefighters’ interest in learning about the results of these 

investigations. 

To bridge the wide gap between level of interest and access to materials among this 

sector of the fire service, firefighters and officers had a number of suggestions. Following 

are some specific suggestions from officers and focus group participants: 

	 Update the FFFIPP mailing list and implement procedures for refreshing the list 

periodically. 

35 
FFFIPP Evaluation 

	 Advertise the mailing list (and how to join it). 

	 Send LODD reports in PDF format via e-mail. 

	 Mail CD-ROMs of FFFIPP findings to the fire departments. 

	 Advertise the e-mail listserv (and how to join it) at all fire stations. 

	 Revise the NIOSH Web site to make it more firefighter-friendly. 

	 Communicate recommendations to the state and local agencies that determine 

funding for fire departments. 

Use Additional Media for Dissemination (98 suggestions) 

Another consistent theme in the focus group discussions and survey data was the 

need for NIOSH to disseminate information from FFFIPP investigations in multiple formats, 

in addition to the LODD reports. Firefighters urged NIOSH to consider popularized versions 

of the reports to make them more accessible to the average firefighter. 

Another common request is for one-page summaries. Both firefighters and officers 

say these would be helpful. Several respondents to the Fire Department Survey also 

recommend brief summaries of findings about specific issues or equipment. These could be 

used easily to train firefighters, as well as to justify budget requests. 

Other Fire Department Survey respondents recommend that NIOSH develop specific 

safety procedure posters that could be placed in the fire stations. Focus group participants 

suggest NIOSH 

	 develop coordinated campaigns around specific issues, focusing on one issue at a 

time to raise awareness throughout the fire service, and 

	 prepare summary documents with statistics showing the number of deaths and 

injuries due to specific unsafe practices, using communication techniques 

employed by the print media. 

Design Materials for Training (26 suggestions) 

Fire department officers also want help translating FFFIPP recommendations into 

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

training materials (including PowerPoint presentations and lesson plans) based on the LODD 

reports. Training officers may spend several hours translating the information in the LODD 

reports into a training tool. Often, this process involves creating PowerPoint presentations 

and identifying visuals to illustrate the LODD report’s text. 

36 
FFFIPP Evaluation 

Partner with Other Organizations to Promote Recommendations (21 suggestions) 

Respondents to the Fire Department Survey recommend that NIOSH partner with 

other organizations to enhance the dissemination of FFFIPP findings. Specific partners the 

officers suggest are trade journals, fire service organizations, and state and federal training 

programs. 

Add Content to Materials on How to Implement Recommendations (13 

suggestions) 

Specific requests for additional information include sample SOPs and other 

management tools for implementing recommendations. Officers from small fire departments 

also request information that is tailored to their budget and size constraints. 

Link with Enforcement (11 suggestions) 

Several respondents to the Fire Department Survey want a link between NIOSH 

recommendations and some form of enforcement. 

Are Needed Supporting Materials Available to Fire Departments? 

(Q51) 

Only about a quarter of fire departments that have seen NIOSH reports 

(24.8 percent) usually have access to documents referenced in NIOSH reports. 

IMPLICATIONS AND RECOMMENDATIONS 

Firefighters have dangerous jobs. They are called on to rescue people and protect 

property under serious and hazardous conditions. They are also exposed to dangers en 

route to emergencies and while responding to roadside incidents. Some 100 firefighters die 

each year on duty, and another 80,000 are injured. 

How many of these deaths and injuries are preventable is unknown. However, the 

knowledge and technology clearly exist to reduce the rates of firefighter fatalities and 

injuries from their current levels. Recommendations developed through NIOSH’s FFFIPP 

point to a number of safety practices that could improve the health and safety of the 

nation’s firefighters. In this section, we present the implications of the evaluation data for 

these issues and suggest approaches NIOSH could consider to address the existing gap 

between safety knowledge and practice in the nation’s fire service. 

Shortfalls persist in current firefighter safety practices. The evidence from this 

evaluation suggests that not all fire departments and firefighters follow FFFIPP 

recommendations. FFFIPP investigations regularly conclude with recommendations that had 

37 
FFFIPP Evaluation 

already been promulgated in prior LODD reports and other NIOSH materials. In the focus 

groups and survey conducted for this evaluation, firefighters and their officers conceded 

that safety practices are not always followed. 

The evaluation provides evidence from the Fire Department Survey and focus groups 

on the extent to which fire departments implement 17 of the most common FFFIPP 

recommendations (which serve as the “sentinel” recommendations for this evaluation). 

The survey data suggest the following, for example: 

 Although about 84 percent of all fire departments have an SOP on the use of 

Incident Command Systems, only 11 percent have one for a physical fitness 

program. 

 More than half of fire departments (60.9 percent) do not require CVD screenings. 

Only 17.0 percent require annual screenings. 

 Only half (52.3 percent) implement a risk management plan when incident 

command is established for a structure fire. 

 Only half (52.1 percent) assign an incident safety officer at least most of the 

time. 

 Less than half of all fire departments (42.4 percent) establish RITs at the fire 

scene at least most of the time. 

 Although more than 80.0 percent of fire departments say the drivers of 

emergency vehicles receive training, only half (54.5 percent) provide refresher 

training once a year or more. NIOSH recommends refresher training twice a year. 

 Only half of fire departments (54.9 percent) say their firefighters use seat belts 

at least “most of the time”; 15.8 percent do not require firefighters to wear seat 

belts while they ride in emergency vehicles. 

 One-fifth of fire departments (21.2 percent) do not have PASS devices for all 

their firefighters to use when fighting structure fires. 

 Almost one-fifth of rural fire departments (19.3 percent) report problems at least 

half the time with their two-way radios, such as bleed over, interference, or loss 

of communication under field conditions. 

Each of these facts represents an opportunity to improve the implementation of 

FFFIPP recommendations. Each of these applicable recommendations has been featured in 

38 
FFFIPP Evaluation 

multiple LODD reports. The shortfall in implementation indicates that better ways are 

needed for transferring existing safety knowledge into practice throughout the fire service. 

Following are key implications from the evaluation data, along with recommendations 

for addressing these implications. 

Small, Volunteer Departments Have the Greatest Challenges to 

Following Safety Guidelines 

In the survey data on fire department safety practices, there are a number of distinct 

patterns that suggest where efforts are most needed to minimize the gap between 

knowledge and practice. With few exceptions, the fire departments that are most likely to 

be implementing FFFIPP recommendations are career departments in large, urban 

jurisdictions, particularly those in the Northeast. Fire departments with lower levels of 

implementation tend to be volunteer or combination career-volunteer departments in small, 

rural jurisdictions, particularly those in the South and Midwest. Small, volunteer fire 

departments typically have fewer financial resources and staff. 

On the basis of these findings, NIOSH may wish to consider a number of outreach 

efforts to improve the dissemination and use of FFFIPP information. 

Recommendation: Outreach Efforts 

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

Existing Resources Limit Safety Practices 

The adequacy of financial and personnel resources appears to play a large role in 

whether a fire department is implementing the FFFIPP recommendations. For example, the 

survey data indicate the following: 

	 Almost half of all fire departments (48.6 percent) do not have enough funding for 

the equipment they need. A third of the departments (31.8 percent) do not have 

enough funding for personally fitted face pieces for their SCBA. (Q42a, 33a) 

	 Two-fifths (39.1 percent) do not have enough funding to train firefighters. (Q42b) 

	 More than half (51.5 percent) do not have enough funding for the personnel they 

need. (Q42c) 

	 Lack of personnel at a fire scene prevents more than half of all fire departments 

from assigning an Incident Safety Officer (51.7 percent) and establishing RITs 

(53.5 percent). (Q25, 28) 

39 
FFFIPP Evaluation 

These findings may suggest that fire departments need help identifying financial 

resources. On the basis of these findings, NIOSH and its partner organizations may wish to 

consider the following recommendations to improve use of the FFFIPP information. 

Recommendations: 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. 

Gaps in Knowledge and Attitudes also Limit Safety 

There is evidence from the evaluation that the knowledge and attitudes of 

firefighters and officers play a role in safety practices: 

	 A quarter of all fire departments (23.4 percent) do not think personally fitted face 

pieces are needed for SCBA (i.e., shared face pieces work fine for their needs); 

about 5.0 percent did not know they were recommended. (Q33a) 

	 About 10 percent say firefighters sometimes do not think they need SCBA. (Q35) 

	 Almost a third (29.4 percent) have never established RITs, and 4.0 percent say 

they do not need them. (Q26,Q28) 

	 A third of the departments (34.9 percent) do not always establish an RIT because 

they think some situations do not warrant one. (Q28) 

	 A third of the fire departments (32.3 percent) say they do not always use an 

Incident Safety Officer because fires are not usually big enough. (Q25) 

On the basis of these findings, NIOSH may wish to consider the following actions. 

Recommendation: NIOSH Web Site 

4. Improve the FFFIPP Web site 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. 

Recommendation: Outreach 

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

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

40 
FFFIPP Evaluation 

organizations as needed, provide relevant FFFIPP materials and offer technical 

assistance to help address safety issues. 

FFFIPP Investigations and LODD Reports Provide Useful Information 

The evidence suggests that LODD reports are valued by many firefighters because 

they are unbiased, detailed, and factual. Learning about specific incidents helps firefighters 

understand safety issues and appears to improve their safety practices. Most fire 

departments (88.2 percent) think the amount of detail provided is about right, but only 

about half of those who had seen these FFFIPP reports say that they are practical, easy to 

understand, specific, and concrete. Fire departments that have experienced an on-duty 

firefighter fatality are more appreciative of the LODD reports than departments that have 

not. 

The experience of a FFFIPP investigation by a fire department was associated with a 

number of firefighter safety practices. Fire departments that had had FFFIPP investigations 

were significantly more likely than others to offer training on several important fire safety 

elements, to make changes to their SOPs and SOGs for major fire safety elements, and to 

have enough SCBA face pieces so that firefighters did not have to share them. 

On the basis of these findings, NIOSH may wish to consider the following actions for 

disseminating the results of individual FFFIPP investigations of on-duty firefighter fatalities. 

Recommendations: 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. 

Fire Departments Need Additional Information in the LODD Reports 

One of the most common suggestions by firefighters and their officers is for 

additional graphics in the LODD reports. Adding a timeline, a diagram of the fire scene, and 

more photos, as well as making more effective use of headings and headlines, would make 

the information presented in the reports more cognitively accessible and more compelling to 

read. The repetition across multiple LODD reports of generic recommendations appears 

41 
FFFIPP Evaluation 

ineffective, however. Many fire department officers say they need more straightforward 

recommendations. 

On the basis of these findings, NIOSH may wish to consider a number of actions to 

improve the value of the FFFIPP information. 

Recommendations: Content of the LODD Reports 

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

diagrams, and other visual aids into the 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. 

Firefighters and Fire Departments Need Information Presented in 

Additional Formats 

The evidence from this evaluation demonstrates that fire departments are already trying to 

improve the knowledge-to-practice translation. Training officers spend hours creating training materials 

based on the LODD reports. Usually, these take the form of PowerPoint slides to which they 

add media clips and other visuals. Because such efforts are more challenging for small, 

volunteer departments to fulfill, the knowledge-to-practice gap could be narrowed by 

NIOSH’s providing departments with training tools based on the FFFIPP’s findings. 

Other officers need guidance and tools for implementing FFFIPP recommendations. 

Needed tools include sample SOPs and materials that could be shared with budget 

authorities and funding agencies to support the departments’ requests for additional 

resources. Officers from small departments also need recommendations that take into 

account their limited financial and personnel resources. 

In addition, firefighters would be more likely to learn about and act on FFFIPP 

recommendations if the information were presented in more accessible formats. These 

range from one-page summaries on specific operational issues (such as the “2 in 2 out” rule 

or the use of Incident Command and RITs), to coordinated campaigns on individual topics. 

They also include longer summary documents (such as the Safety First document NIOSH 

has developed) with updated graphics and formatting, as well as video reenactments and 

other more popularized materials. 

On the basis of these findings, NIOSH may wish to consider a number of actions to 

improve the dissemination and use of the FFFIPP information. 

42 
FFFIPP Evaluation 

Recommendations: Ancillary Materials 

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

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

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

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. 

FFFIPP Materials Need to Be Better Marketed and Distributed 

The evaluation data indicate that, although most fire departments are aware of 

FFFIPP reports, more than one-quarter (26.8 percent) have never seen a FFFIPP report. 

Many fire departments are unaware of FFFIPP resources. Firefighters do not understand the 

FFFIPP’s role or how FFFIPP investigations are conducted. Over half of all officers 

(54.3 percent) are not familiar with the FFFIPP. Among small departments, 62 percent are 

not aware of the FFFIPP. Similarly, participants in the focus groups suggested a number of 

ideas for presenting FFFIPP findings that demonstrated they were not aware of already 

existing NIOSH resources. These resources include the NIOSH Web site, the FFFIPP CDROM, and the summary reports. 

These findings suggest that there is room for improvement in the way current FFFIPP 

documents are disseminated. NIOSH could improve its impact by better marketing existing 

resources and by diversifying the communication channels used for dissemination. 

Firefighters and their officers offer a number of suggestions to address this issue. 

On the basis of these findings, NIOSH may wish to consider a number of actions to 

improve the dissemination and use of the FFFIPP information. 

Recommendations: Distribution 

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

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

43 
FFFIPP Evaluation 

15. Ensure that NIOSH e-mail lists are up to date (e.g., with an e-mail cohort 

maintenance or refresher program that generates automatic e-mails to listserv 

members to confirm addresses). 

Recommendations: Marketing 

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

station bulletin boards, with the NIOSH Web site featured prominently. 

17. Consider coordinated promotional campaigns on single themes. 

Increasing Awareness of the FFFIPP and FFFIPP Investigations Will 

Likely Improve Safety Practices 

In both the focus group discussions and the survey responses, firefighters made it 

clear that they are more receptive to safety information when its importance is reinforced 

by media coverage, political pressure, potential sanctions from insurance companies, state 

occupational safety and health agencies, and their officers. 

This finding suggests that there is an opportunity to increase knowledge of FFFIPP 

recommendations by increasing awareness of the program itself. Raising the FFFIPP 

investigators’ profiles, for example, would likely raise the attention given to investigation 

reports, which in turn would increase the attention firefighters, fire departments, and local 

funding authorities would give to the FFFIPP recommendations. The recommendation at the 

2006 NIOSH stakeholders’ conference that FFFIPP investigators wear identifiable clothing 

(i.e., caps and jackets with the NIOSH acronym) was an acknowledgment of this causal link 

in the knowledge-to-practice chain. 

Recommendations: Marketing 

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

the fire service and the public. 

REFERENCES 

Centers for Disease Control and Prevention (CDC). (2006). Fire fighter fatality investigation 

and prevention program: Program description. Retrieved June 30, 2006, from 

http://www.cdc.gov/niosh/fire/implweb.html 

Deville & Sarndal. (1992). Calibration estimation in survey sampling. JASA, 87, 376-382. 

Fahy, R. F. (2005). U.S. firefighter fatalities due to sudden cardiac death, 1995-2004. Fire 

Analysis and Research Division, National Fire Protection Association, June 2005. 

Retrieved June 29, 2006, from http://www.nfpa.org/assets/files/PDF/ 

OSCardiacDeath.pdf 

44 
FFFIPP Evaluation 

Fahy, R. F. (2006). U.S. firefighter deaths related to training, 1996-2005. Fire Analysis and 

Research Division, National Fire Protection Association, June 2006. Retrieved June 

29, 2006, from http://www.nfpa.org/assets/files//PDF/OS.FFFtraining.pdf 

Fahy, R. F., & LeBlanc, P. R. (2006). Firefighter fatalities in the United States—2005. Fire 

Analysis and Research Division, National Fire Protection Association, June 2006. 

Retrieved June 29, 2006, from http://www.nfpa.org/assets/files/PDF/osfff.pdf 

Folsom & Singh. (2000). The generalized exponential model for sampling weight calibration 

for extreme values, non-response, and post-stratification. ASA Proc. Surv. Res. 

Meth. Sec., 598-603. 

Karter, M. J. (2005). U.S. fire department profile, September 2005. Abstract. Retrieved June 

29, 2006, from http://www.nfpa.org/itemDetail.asp?categoryID=417&itemID= 

18246&URL=Research%20&%20Reports/One-Stop%20Data%20Shop/Statistical% 

20reports/Fire%20service%20statistics 

Miles, M. B., & Huberman, M. (1994). An expanded sourcebook of qualitative data analysis 

(2nd ed.). Thousand Oaks, CA: Sage Publications. 

National Institute for Occupational Safety and Health (NIOSH). (2004, draft). NIOSH fire 

fighter fatality investigation and prevention program. Leading recommendations 

1998-2002. 

US Census. (2003). Census 2000 Urban and Rural Classification. July 28, 2003. Accessed on 

1/15/04 at http://www.census.gov/geo/www/ua/ua_2k.html 

45 
FFFIPP Evaluation 

APPENDIX A. SENTINEL RECOMMENDATIONS FOR THE FFFIPP 

EVALUATION 

DOMAIN #1: INCIDENT COMMAND 

Recommendation #1: Fire Departments should establish and implement an Incident Command 

System with written standard operating procedures for all firefighters. 

Recommendation #2: Ensure that the Incident Command always maintains close accountability for 

all personnel at the fire scene. 

Recommendation #3: Ensure that Incident Command conducts an initial size-up of the incident 

before initiating firefighting efforts and continually evaluates the risk versus gain during operations 

at an incident. 

Recommendation #4: Ensure that a separate Incident Safety Officer, independent from the 

Incident Commander, is appointed. 

DOMAIN #2: MOTOR VEHICLE SAFETY 

Recommendation #1: Ensure that all firefighters riding in emergency fire apparatus are wearing 

and are properly belted and secured by seat belts. 

Recommendation #2: Ensure all drivers of fire department vehicles are responsible for the safe 

and prudent operation of the vehicle under all conditions. 

Recommendation #3: Ensure all drivers of fire department vehicles receive driver training at least 

twice a year and document the training. 

DOMAIN #3: EQUIPMENT 

Recommendation #1: Develop and implement a preventive maintenance program to ensure that 

all Self-contained Breathing Apparatus are adequately maintained. 

Recommendation #2: Fire departments, emergency medical services, and other users of 

automated external defibrillators should follow the manufacturers’ instructions to replace battery 

packs immediately when the unit indicates a low battery or replace battery message. 

Recommendation #3: Fire departments should develop and implement a policy requiring the use 

of Personal Protective Equipment and protective clothing. 

DOMAIN #4: RADIO COMMUNICATION 

Recommendation #1: Fire departments should ensure those firefighters who enter hazardous 

areas, e.g., burning or suspected unsafe structures, are equipped with two-way communications 

with incident command. 

Recommendation #2: Ensure that firefighters are equipped with a radio that does not bleed over, 

cause interference, or lose communication under field conditions. 

DOMAIN #5: SAFETY ON THE FIREGROUND 

Recommendation #1: Ensure that a Rapid Intervention Team is established and in position 

immediately upon arrival. 

Recommendation #2: Fire departments should strictly enforce the wearing and use of PASS 

devices when firefighters are involved in firefighting, rescue, and other hazardous duties. 

Recommendation #3: Ensure that officers enforce and firefighters wear their SCBAs whenever 

there is a chance they might be exposed to a toxic or oxygen-deficient atmosphere, including the 

initial assessment. 

DOMAIN #6: FITNESS/WELLNESS 

Recommendation #1: Fitness/wellness programs should be mandatory. 

Recommendation #2: Conduct medical evaluations to screen firefighters for coronary artery 

disease (CAD) risk factors and CAD. 

46 
FFFIPP Evaluation 

APPENDIX B. DEFINITIONS OF THE STRATIFICATION 

VARIABLES 

Census region The US Census Bureau’s definition of the four geographic regions as 

applied to the state in which the fire department is located. The four 

geographic regions will be defined as follows: 

1.	 Northeast—Connecticut, Maine, Massachusetts, New 

Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, 

Vermont 

2.	 South—Alabama, Arkansas, Delaware, Florida, Georgia, 

Kentucky, Louisiana, Maryland, Mississippi, North Carolina, 

Oklahoma, South Carolina, Tennessee, Texas, Virginia, West 

Virginia, plus the District of Columbia 

3.	 Midwest—Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, 

Missouri, Nebraska, North Dakota, Ohio, South Dakota, 

Wisconsin 

4.	 West—Alaska, Arizona, California, Colorado, Hawaii, Idaho, 

Montana, Nevada, New Mexico, Oregon, Utah, Washington, 

Wyoming 

Department type	 Percentage of firefighters who are paid, career versus volunteer 

firefighters: 

1.	 All career—100% career firefighters 

2.	 Mostly career—51% to 99% career firefighters 

3.	 Mostly volunteer—1% to 50% career firefighters 

4.	 All volunteer—100% volunteer firefighters 

Jurisdiction type	 The population density of the area served by a fire department 

(population protected by square miles covered):a 

1.	 Urban—fire departments with at least 825 persons per square 

mile 

2.	 Rural—fewer than 825 persons per square mile 

Jurisdiction size	 Size of protected population as reported on the NFPA database: 

1.	 Large—at least 50,000 persons protected 

2.	 Medium—at least 5,000 and fewer than 50,000 persons 

protected 

3.	 Small—fewer than 5,000 persons protected 

a This definition assumes that 65 percent of the fire department’s coverage area would be considered 

the central area, and 35 percent of the coverage area would be considered the surrounding area. In 

the 2000 Census, the US Census Bureau defines “urban” as all territory, population, and housing 

units located within an urbanized area or an urban cluster. The Census Bureau defines urbanized 

areas and urban clusters as densely populated areas that consist of core block groups or blocks with 

a population density of at least 1,000 people per square mile and surrounding census blocks that 

have an overall density of at least 500 people per square mile (US Census, 2003). 

47 
FFFIPP Evaluation 

APPENDIX C. FIRE DEPARTMENT SURVEY: SAMPLE SIZES, 

ELIGIBILITY RATES, AND RESPONSE RATES 

Sample Eligibility Response 

Characteristic Size Rate Rate 

Total 3,000 98.5 54.9 

High-priority strata 

Total 425 98.4 62.7 

Strata 

Previous FFFIPP investigation involving a traumatic 

injury fatality 117 100.0 70.9 

Previous FFFIPP investigation involving a cardiovascular 

CVD fatality 91 95.6 66.7 

Traumatic injury fire fighter fatality without 

investigation 120 98.3 54.2 

Cardiovascular disease fire fighter fatality without 

investigation 95 98.9 60.6 

10 largest fire departmentsa

 2 100.0 0.0 

Remainder strata 

Total 

2,575 98.5 53.6 

Census region 

Northeast 542 99.6 49.3 

South 879 98.2 50.2 

Midwest 780 98.3 59.1 

West 374 97.9 56.8 

Rural/urban 

Rural 1,555 98.8 53.6 

Urban 613 98.9 68.0 

Unknown 407 96.8 31.7 

Size (defined by population protected) 

Large (at least 50,000 persons) 279 98.2 77.0 

Medium (5,000-49,999 persons) 752 98.9 63.3 

Small (0-4,999 persons) 1,544 98.3 44.7 

Department type 

All career 359 98.9 76.3 

All volunteer 816 97.5 50.8 

a Eight of the 10 largest fire departments are counted in the other high priority strata. 

Note: Eligibility and response rates displayed in this table are unweighted percentages. 

48 
FFFIPP Evaluation 

APPENDIX D. FIRE DEPARTMENT QUESTIONNAIRE 

49 
Exhibit A-1. Questionnaire

OMB No: 0920-0697 

Exp. Date: 10/31/2007 

Fire Fighter Fatality Investigation and Prevention 

Program (FFFIPP) Evaluation 

Fire Department Survey
 

Conducted by: RTI International 

Sponsored by: National Institute for Occupational Safety and Health (NIOSH) and the
 

Centers for Disease Control and Prevention (CDC) 
Dear Fire Chief, 

The Fire Department Survey is being conducted for the National Institute for 

Occupational Safety and Health (NIOSH). In 1998, Congress funded NIOSH to create 

the Fire Fighter Fatality Investigation and Prevention Program (FFFIPP). Through the 

FFFIPP, NIOSH studies the events that lead to firefighter deaths and makes 

recommendations to help prevent firefighter deaths and serious injuries. 

This survey is part of an evaluation that NIOSH is conducting to learn about the 

usefulness of the Fire Fighter Fatality Investigation and Prevention Program. The 

FFFIPP Evaluation will supply information to improve the value of the program. In 

addition to this survey, the evaluation also includes focus groups with firefighters. These 

focus groups are organized separately from this survey and will involve individual 

firefighters from across the country. 

Your fire department has been selected as one of approximately 3,000 fire 

departments from across the country to take part in the survey. The Fire Department 

Survey should be answered by either the fire chief, the chief safety officer and/or a 

training officer for your fire department. Questions in the survey ask about department 

policies and procedures that may potentially have an impact on firefighter safety. The 

survey should take about 25 minutes to finish. After completing the survey, please send 

it back to us in the enclosed envelope. There is no cost to your fire department for the 

postage. 

RTI International, a non-profit research organization, is conducting the FFFIPP 

Evaluation for NIOSH. The answers we get from your fire department will be used to 

further develop and improve the Fire Fighter Fatality Investigation and Prevention 

Program. Being a part of this study is voluntary, but your answers are important to us. 

Please be assured that the answers you provide will be kept private. The results from this 

survey will be reported in aggregate form so that specific answers cannot be connected to 

you or your fire department. 

If you have any questions about this survey or about the FFFIPP Evaluation in 

general, please feel free to call me toll-free at 1-800-334-8571, x7722. If you have a 

question about your rights as a study participant, you can call RTI’s Office of Research 

Protection toll-free at 1-866-214-2043. 

Thank you very much for helping with this important study. 

Sincerely, 

Kristina Peterson, Ph.D. 

Project Director, FFFIPP Evaluation 
Instructions 

y

y

y

y

y

y

y

 Use a No. 2 pencil or black pen only 

 Make heavy dark marks inside the boxes 

 Erase cleanly any answer you wish to change 

 If asked to “specify” or “explain” on the survey, please 

write your response in the space provided. 

 If asked to “MARK ALL THAT APPLY,” please mark 

all of the appropriate answers to these questions 

 If any question does not apply to you or you are not sure 

what it means, just leave it blank 

 Make no other marks or comments on the survey pages, 

since they interfere with the automatic reading 

This kind of mark will work: 

(Correct Mark) 

⌧ 

These kinds of marks will NOT work: 

(Incorrect Marks) 

  ;  

SECTION 1. TRAINING AND SAFETY 

The following questions ask about your department's policies and procedures for training and safety. It 

is important to get accurate data on what fire departments are currently doing so that NIOSH can 

improve the FFFIPP program. Please answer the survey questions as honestly and to the best of your 

ability as possible. Your answers will be kept private, and will in no way be connected to you or your 

fire department. 

1. Does your department have a Safety Officer? 

No [ → SKIP TO QUESTION 2 ] 

Yes 

1a. What kind of a position does your Safety Officer have within your department? 

Full-time paid position 

Part-time paid position 

Volunteer position 

Other (Please specify:______________________________________) 

1b. Has your Safety Officer been certified by the Fire Department Safety Officers 

Association (FDSOA) or some other organization? 

No, not certified 

Yes, certified by FDSOA 

Yes, certified by some other organization (Please specify: _________) 

2. Does your department have a Training Officer? 

No 

Yes 
3. Some fire departments use Standard Operating Procedures (SOP) or Standard Operating

 Guidelines (SOG) to describe how certain situations should be approached. For which of the

 following does your department have SOPs/SOGs in place? MARK ALL THAT APPLY. 

Incident Command Systems 

Maintenance of SCBAs 

Motor vehicle safety 

Participation in a personal physical fitness program 

Participation in regular health screenings for cardiovascular disease (CVD) 

Rapid Intervention Teams (RITs), also known as Rapid Intervention Crews 

(RICs) or Firefighter Assistance and Search Teams (FAST) 

Use of Personal Alert Safety System (PASS) devices 

Use of personal protective equipment and protective clothing 

Use of radio communications 

Other (Please specify:____________________________________________) 

Does not apply. Our fire department does not use SOPs/SOGs. 

4. Do your firefighters receive training on any of the topics listed below? If so, is training

 optional or required? Please place an "X" in the appropriate box for each topic below. 

a. Fighting structure fires 

No 

Training 

Optional 

Training Required

 Training 

b. Driving safety 

c. Incident Command systems 

d. Maintenance of Self-Contained 

Breathing Apparatuses (SCBAs) 

e. Rapid Intervention Teams (RITs) 

f. Use of personal protective equipment

 and /or protective clothing 

g. Use of radio communication devices 

5.	 Who provides training to your firefighters? MARK ALL THAT APPLY. 

Our department's Training Officer 

Other officers within our department 

State fire training agency 

United States Fire Administration's (USFA) National Fire Academy in 

Emmitsburg, MD 

Conferences or regional meetings 

Other (Please specify:____________________________________________) 
6. What other trainings have your firefighters attended in the last 12 months? MARK ALL THAT APPLY. 

Roadside incidents/Motor Vehicle Accidents (MVA) 

Scuba diving 

Swift water rescue 

Wildland fire fighting 

HAZMAT 

Other (Please specify:____________________________________________) 

SECTION 2. HEALTH AND SAFETY INFORMATION 

The following questions ask about your department's policies and procedures for obtaining 

health and safety information. 

7.	 There are many sources of health and safety information used by fire departments. Please

 indicate which of the following organizations your department has used to gain health and 

safety information. Please mark "X" in the box to indicate which mode (e.g., email, magazine,

 training, etc.) your department has used to get information from each organization. 

Websites/

 email

 messages 

Magazines/ 

newsletters 

Conferences/

 meetings 

Training/

 courses

 Not 

Applicable, 

I do not use 

information

 from this 

organization 

National Institute for 

Occupational Safety 

and Health (NIOSH) 

Occupational Safety & 

Health Administration 

(OSHA) 

Federal Emergency 

Management Agency

 (FEMA) 

United States Fire 

Administration (USFA) 

International 

Association of Fire

 Chiefs (IAFC) 

International 

Association of 

Firefighters (IAFF) 

National Volunteer Fire 

Council (NVFC)

National Fire Protection 

Association (NFPA) 

Fire Department Safety 

Officers Association 

(FDSOA) 

Other (Please specify: 

__________________ 

__________________) 
8.	 How familiar are you with the National Institute for Occupational Safety and Health (NIOSH)? 

Not at all familiar
 

Not very familiar
 

Somewhat familiar
 

Very familiar
 

9. How familiar are you with NIOSH's Fire Fighter Fatality Investigation and Prevention

 Program (FFFIPP)? 

Not at all familiar 

Not very familiar 

Somewhat familiar
 

Very familiar
 

10.	 How does your department receive information about NIOSH's firefighter safety and

 health recommendations? MARK ALL THAT APPLY. 

NIOSH mailings 

National conference presentations 

State-level conference presentations 

Other firefighters or departments 

At seminars or other training opportunities (not conferences) 

Trade publications (such as Firehouse and Fire Engineering) 

NIOSH website 

Links from other websites (such as NFPA and Firehouse) 

Media reports - newspaper, television, radio 

Other (Please specify:____________________________________________) 

Does not apply. We have not received information about NIOSH 

recommendations. [→ SKIP TO QUESTION 12] 

11. In what ways has your department used NIOSH recommendations? MARK ALL THAT APPLY. 

Made changes to training program
 

Developed new SOPs/SOGs
 

Made changes to SOPs/SOGs
 

Justified current budget/staffing
 

Made new budget/staffing requests
 

Justified grant applications
 

Does not apply. We have not used NIOSH recommendations.
 

[→ SKIP TO QUESTION 12] 
11a. Please describe the changes you made: 

11b. Can you identify topics of NIOSH recommendations that you have used for training

 purposes? If so, MARK ALL THAT APPLY. 

Traffic hazards 

Personal protective equipment and clothing 

SCBA 

PASS systems 

Incident Command systems 

Radio communications 

Physical fitness and cardiovascular disease (CVD) 

Building code compliance (e.g., warning against the use of wooden trusses) 

Other (Please specify:____________________________________________) 

Does not apply. We have not used NIOSH recommendations for training 

purposes. [→ SKIP TO QUESTION 12] 

SECTION 3. FITNESS AND WELL-BEING 

The following questions ask about your department's policies and procedures for encouraging 

firefighter fitness and general well-being. 

12. Does your department have a fitness training that involves physical exercise and/or

 other health promotion activities (for example a cardiovascular fitness program, physical

 training program, wellness program, or other fitness program)? 

No 

Yes, it's required 

Yes, it's optional (Please explain:____________________________) 

13. How often do your firefighters receive screenings for cardiovascular disease (CVD) 

and its risk factors? 

One time, when they first join the department
 

Less frequently than once a year
 

One time a year
 

More than one time a year
 

Does not apply. Firefighters are not required to receive CVD screenings 
SECTION 4. DRIVING SAFETY 

The following questions ask about your department's policies and procedures for encouraging 

firefighter fitness and general well-being. 

14. Do all drivers of vehicles responding to emergency calls receive driver training 

before being allowed to operate the vehicles? MARK ALL THAT APPLY. 

No
 

Yes, they receive training required by the department
 

Yes, they receive training required by the state
 

Yes, they receive optional training
 

15. How often do drivers of your fire department vehicles receive "refresher" driver 

training to continue being allowed to drive the vehicles? 

Two or more times a year 

Once every year 

Less frequently than once a year 

Does not apply. Firefighters are not required to receive continuing 

driver training. 

16. Does your fire department have a requirement regarding seat belt use in emergency vehicles? 

No
 

Yes
 

17. To what extent do you agree or disagree that your firefighters are able to fit 

comfortably in their seatbelts while wearing turnout gear in your emergency vehicles? 

Strongly disagree
 

Disagree
 

Neither agree nor disagree
 

Agree
 

Strongly agree
 

18. About how often do you think your firefighters use their seatbelts when riding in the 

emergency vehicles? 

Never 

Some of the time 

About half the time 

Most of the time
 

Always
 
SECTION 5. STRUCTURE FIRES 

The following questions ask about your department's experience with as well as policies 

and procedures for dealing with structure fires. 

19. Approximately how many emergency calls did your department respond to in the past 

12 months?
 

Total number of emergency calls
 

20. Of the emergency calls your department responded to in the past 12 months, about 

how many of these were structure fires? 

Total number of structure fires 

21. How often is Incident Command established when responding to structure fires? 

Never
 

Rarely
 

About half the time
 

Most of the time
 

Always [→ SKIP TO QUESTION 23]
 

22. What are the reasons why Incident Command is not always established by your 

fire department? MARK ALL THAT APPLY. 

Fires are not usually big enough to require an Incident Commander 

Not enough firefighters available at the scene of the fire 

Other (Please specify:____________________________________________)
 

Does not apply. My department always assigns an Incident Commander for structure fires.
 

23. When Incident Command is established for a structure fire, what are the Incident 

Commander's responsibilities? MARK ALL THAT APPLY. 

Conduct an initial assessment before the other firefighters begin entering the building 

Develop and coordinate the fire attack strategy 

Develop and initiate a risk management plan 

Document all assessments, plans and events related to the fire 

Ensure that at least four (4) firefighters are on the scene before entering the building 

Establish a collapse zone around the building 

Establish Rapid Intervention Team (RIT) or Rapid Intervention Crew (RIC) 

Identify and implement a communication strategy 

Monitor location of all firefighters at the scene 

Other (Please specify:____________________________________________) 
24. About how often does an Incident Commander assign an Incident Safety Officer 

when responding to structure fires? 

Never
 

Some of the time
 

About half the time
 

Most of the time
 

Always [→ SKIP TO QUESTION 26] 
 

25. What are the reasons why an Incident Commander does not always assign an 

Incident Safety Officer? MARK ALL THAT APPLY. 

Fires are not big enough to require an Incident Commander 

Not enough firefighters are available at the scene of the fire 

Other (Please specify:____________________________________________) 

Does not apply. Our Incident Commanders always assign an Incident Safety 

Officer for structure fires. 

26. How often are Rapid Intervention Teams (RITs) or Rapid Intervention Crews (RICs)

 available at structure fires? 

Never [→ SKIP TO QUESTION 28]
 

Some of the time
 

About half the time
 

Most of the time
 

Always [→ SKIP TO QUESTION 29] 
 

27. In what situations are RITs/RICs established? MARK ALL THAT APPLY. 

When the building has more than one story/floor 

When there are enough firefighters on hand at the scene of the fire 

Whenever firefighters enter a burning building 

Other (Please specify:____________________________________________) 

28. What are the reasons why your fire department does not use RITs/RICs in every 

structure fire? MARK ALL THAT APPLY. 

The structure fire may not be large enough to need an RIT/RIC 

We don't have enough equipment, SCBAs, or turnout gear to establish an RIT/RIC 

We don't have enough firefighters available at the scene of the fire 

We don't have enough training or trained personnel at the scene to establish an RIT/RIC 

We have never established an RIT/RIC 

We use other fire departments in the area for RITs/RICs 

We use other safety practices and so we don't need them 

Other (Please specify:____________________________________________) 
29. Does your fire department have enough Personal Alert Safety System (PASS) devices for 

all firefighters for use when fighting structure fires? 

No
 

Yes
 

30. About how often do you think your firefighters wear their PASS devices when fighting 

structure fires? 

Never
 

Some of the time
 

About half the time
 

Most of the time
 

Always [→ SKIP TO QUESTION 32] 
 

31. Why do you think your firefighters do not use their PASS devices more often? 

MARK ALL THAT APPLY. 

They don't have a PASS device to use
 

Situation doesn't require them
 

Firefighters think the devices do not always work reliably
 

Firefighters don't think they need them
 

Devices go off while firefighters are resting
 

32. Does your department have Self Contained Breathing Apparatuses (SCBA) for your 

firefighters to use when combating structure fires? 

No [→ SKIP TO QUESTION 37]
 

Yes
 

33. Do your firefighters ever have to share facepieces for SCBAs? 

No [→ SKIP TO QUESTION 34] 

Yes 

33a. What are the reasons why your fire department does not have personallyfitted SCBA facepieces for all of your firefighters? MARK ALL THAT APPLY. 

Didn't know it was recommended 

Firefighters don't like using the equipment 

Have never needed them (e.g., we don't do interior attacks) 

They cost too much, there is not enough money in the budget 

We don't have enough equipment for all of our firefighters 

Shared systems work fine for our needs 

Other (Please specify:______________________________________) 
34. About how often do you think your firefighters use SCBAs while fighting structure fires? 

Never
 

Some of the time
 

About half the time
 

Most of the time
 

Always [→ SKIP TO QUESTION 36] 
 

35. Why do you think your firefighters do not use SCBAs more often when fighting 

structure fires? MARK ALL THAT APPLY. 

Situation doesn't require them 

Firefighters do not trust that the SCBAs will work reliably 

Firefighters don't think they need them 

Firefighters don't like sharing facepieces with others 

Firefighters are concerned that the SCBA may be or become contaminated 

Wearing SCBAs makes it more difficult to work 

Firefighters don't have SCBAs to use 

36. How often is routine maintenance performed on your SCBAs? 

After every time they are used 

Once a month or more 

Several times a year 

Once a year 

Less than once a year 

Never. Maintenance has not been done on our SCBAs. 

Does not apply. My department does not have SCBAs. 

37. How many Chemical/Biological/Radiological/Nuclear (CBRN) SCBAs--with the 

label shown below--are available (or on order) for use by firefighters within your 

department at this time? 

Number available now: [→ SKIP TO QUESTION 38] 

Number on order: [→ SKIP TO QUESTION 38] 

Does not apply. My department does not have CBRN SCBAs. 
37a. What are the reasons why your fire department does not have CBRN SCBAs?

 MARK ALL THAT APPLY. 

CBRN SCBA devices are not needed in our department 

We didn't know they were available 

We don't have adequate technical information to purchase them 

We don't have adequate funding to purchase them 

Other (Please specify:_________________________________________) 

38. Does your fire department have Automated External Defibrillators (AEDs)? 

No [→ SKIP TO QUESTION 39]
 

Yes
 

38a. At your fire department, where do you have AEDs? 

At the fire station(s)
 

On the emergency vehicles (or apparatus)
 

Both at the fire station(s) and on the vehicles (or apparatus)
 

39. How often has routine maintenance, including replacement of battery packs, been performed 

on your AEDs? 

After every time they are used
 

Once a month or more
 

Several times a year
 

Once a year
 

Less frequently than once a year
 

Never. Maintenance on our AEDs has not been done.
 

40. About how often do your firefighters carry radios or other two-way communication 

devices while responding to structure fires? 

Never 

Some of the time 

About half the time 

Most of the time
 

Always
 

41. Some radios and other two-way communication devices can have problems under 

field conditions, such as bleed-over, interference, or loss of communication. About how 

often do your communication devices have these or other problems? 

Never
 

Some of the time
 

About half the time
 

Most of the time
 

Always
 
42. How would you rate your department's budget in the following areas? 

Not 

adequate Adequate 

More than 

adequate 

a. Equipment 

b. Training 

c. Personnel 

SECTION 6. EDUCATIONAL MATERIAL 

The following questions ask about your policies and procedures for providing educational 

material to firefighters and others within your department. In addition, there are a number of 

questions asking about familiarity and satisfaction with the educational materials provided 

by NIOSH and the FFFIPP. 

43. How often have you seen NIOSH reports that describe recent firefighter fatalities and 

make recommendations for avoiding similar incidents? Please refer to the insert sheet 

included with this survey for examples of NIOSH firefighter safety reports. 

Never [→ SKIP TO QUESTION 53]
 

One or two times per year
 

Several times per year
 

Once a month or more
 

44. How does your department receive the NIOSH Fire Fighter Fatality Investigation 

reports? MARK ALL THAT APPLY. 

By mail
 

On the Internet
 

From colleagues in other departments
 

At conferences or other meetings
 

45. Have you read part or all of a NIOSH Fire Fighter Fatality Investigation report in the 

last 12 months? 

No
 

Yes
 
46. Which parts of the NIOSH reports do you usually read? MARK ALL THAT APPLY. 

Summary
 

Investigation Results
 

Discussion
 

Recommendation
 

47. Overall, how would you rate the amount of detail in the NIOSH reports? 

Too little detail
 

About the right amount of detail
 

Too much detail
 

48. Which parts of the NIOSH reports do you think should be changed in length? 

Eliminate 

entirely 

Make 

shorter

 Don't 

change the

 length

 Make 

longer 

a. Summary 

b. Investigation results 

c. Discussion 

d. Recommendation 

49. Do you have any other suggestions for how the NIOSH reports could be improved? 

50. Does the fire department disseminate the information it receives from NIOSH to the

 firefighters? 

No [→ SKIP TO QUESTION 51]
 

Yes
 
50a. How is this information disseminated to firefighters? MARK ALL THAT APPLY. 

Regular staff meetings 

Training sessions 

Provide copies of NIOSH reports to firefighters 

Provide copies of NIOSH report summaries to firefighters 

Provide summaries prepared by department to firefighters 

Postings on bulletin boards 

Post report on the department website 

Send message to firefighters by email 

Other (Please specify:_________________________________________) 

51. The NIOSH reports sometimes reference other documents, such as guidelines or more

 detailed technical reports. Does your fire department usually have access to documents

 that are referenced in NIOSH reports? 

No
 

Yes
 

52. NIOSH reports always include recommendations that are designed to help improve the health

 and safety of firefighters. How much do you agree or disagree with the following statements

 about the NIOSH recommendations: 

Strongly 

Disagree Disagree 

Neither 

Agree

 nor 

Disagree Agree 

Strongly

 Agree 

a. Recommendations are 

practical 

b. Recommendations are easy 

to understand 

c. Recommendations are 

specific and concrete 

53. What other NIOSH materials have you seen? MARK ALL THAT APPLY. 

Pocket guide to chemical hazards 

Respirator maintenance program guide 

CDs of firefighter program materials 

Alerts 

Hazard IDs 

Workplace Solutions 

Other (Please specify:______________________________________) 

None. I have not seen any NIOSH materials. [→ SKIP TO QUESTION 54] 
53a. How satisfied or dissatisfied are you with these NIOSH materials? 

Very dissatisfied 

Dissatisfied 

Neither satisfied nor dissatisfied 

Satisfied 

Very satisfied 

54. Have you ever visited the NIOSH website at www.cdc.gov/niosh/firehome.html? 

No 

Yes, in the last year 

Yes, longer than one year ago 

55. In which of these ways would you most prefer to receive information about NIOSH 

recommendations? MARK YOUR THREE (3) FAVORITES. 

Cable television programming 

CD/DVD 

Conference presentations or meetings 

Email 

Fire Fighter Fatality Investigation Reports 

NIOSH Website 

One-page Fact Sheets 

Pocket Guides 

Posters 

Summary Reports 

Training session/class 

Other (Please specify:____________________________________________) 

56. What could NIOSH do to improve the way the recommendations are communicated

 to fire departments? 
SECTION 7. YOUR DEPARTMENT INFORMATION 

The following questions ask about your department. These questions will help us understand your survey 

responses as they relate to the size of your department. 

57. How many career and volunteer firefighters currently work at your fire department? 

(Please count only those who are involved in fire suppression) 

Full-time (career) uniformed firefighters 

Part-time (career) uniformed firefighters 

Part-time (on-call or volunteer) firefighters 

58. How many fire stations do you currently have in your fire department? 

Number of fire stations: 

59. What type of jurisdiction does your fire department serve? 

Rural (population density is less than 825 persons per square mile) 

Urban (population density is more than 825 persons per square mile) 

60. What is the size of the population your fire department serves? 

Small (protecting a population of less than 5,000) 

Medium (protecting a population of 5,000 to 49,999)
 

Large (protecting a population of 50,000 or more)
 

61. During the past 5 years, has your department experienced a firefighter fatality? 

No 

Yes, due to a cardiovascular event (e.g., heart attack, heart disease, stroke, etc.) 

Yes, due to a vehicle accident while responding to or returning from a call 

Yes, due to a traumatic injury or accident on the fire ground 

Yes, due to some other reason (please specify: ______________________) 

62. Who completed this survey? 

Fire Chief 

Safety officer 

Training officer
 

Other (Please specify:____________________________________________)
 

Thank you for taking the time to answer this survey. 

Please return this survey to RTI in the provided envelope. 
FFFIPP Evaluation 

APPENDIX E. STATISTICAL METHODOLOGY 

Post-Data Collection Methodology 

Building the Analysis File 

All questionnaire data from responding fire departments were pooled into one 

analysis file. This file included the sample weights, sample design information, and any 

variables needed for proper estimation of variance. A codebook of this analysis file was 

created that displayed weighted and unweighted frequencies and percentages for all 

variables. The codebook provides information on item nonresponse and sample sizes. 

Methodology Used to Create the Sample Weights and Estimates 

One final, nonresponse-adjusted sample weight was created for each responding fire 

department. This weight consists of a product of two factors: the base weight and the 

nonresponse adjustment. These are defined as follows: 

1. The base weight is the inverse, unconditional probability of selecting the fire 

department into the sample. This weight accounts for the clustering and 

stratification used in the sample design. Note that if all selected fire departments 

respond to the survey, then the sum of the base weight will equal the total 

number of fire departments on the sample frame, and no nonresponse 

adjustment would be necessary. 

2. The nonresponse adjustment is an adjustment imposed on the sampling 

weight of fire department respondents to account for those departments that did 

not respond to the survey. In general, this adjustment was greater than “1” so 

that each respondent fire department will account for itself as well as some 

portion of the nonrespondents in the final estimate. 

There are numerous ways of constructing a nonresponse adjustment. We used a 

response propensity model-based approach described recently in Folsom and Singh (2000). 

The Folsom and Singh modeling approach is based on a simple generalization of constrained 

models first suggested by Deville and Sarndal (1992). These models allow the user to 

impose predetermined constraints on the resulting model-based nonresponse adjustment to 

minimize the effect that the weight adjustment has on variance. The variance reduction 

property of the adjustments is another distinct advantage of this approach. 

The modeling approach has been used in recent years to generate nonresponse 

adjustments because (1) it has been proven to be a cost-efficient approach for creating 

50 
FFFIPP Evaluation 

nonresponse adjustments and (2) potential bias reduction can be achieved over the 

commonly used weighting class approach. This increases bias reduction because the 

adjustment uses more statistically significant main effects and lower-order interactions than 

a weighting class approach. Also, if the resulting response propensity model contains all 

main effect and interaction terms for a set of categorical variables, the modeling approach 

to deriving the weighting adjustments is numerically equivalent to the weighting class 

approach. Consequently, the modeling approach is a generalization of the weighting class 

approach. 

For the FFFIPP survey response propensity model, we considered those variables that 

we suspect will be significant predicators of response propensity. The statistical significance 

of these variables was tested during the model-building process. The statistical significance 

of lower-order interactions of these variables was also considered. 

To illustrate, we will let 

i = indice for fire department, 

ρi = unconditional probability of selecting the fire department into the Fire 

Department sample, and 

αi = nonresponse adjustment. 

ρ−1 The base weight for fire department i will equal i , and the final weight will equal 

ρ−1wi = i × α . (E.1) i

The survey weights for the Fire Department Survey are summarized in Exhibit E-1. 

After the data were collected, we produced estimates of population percentages. In 

summary, these were computed as follows. We will let 

δi = a 0/1 indicator identifying those fire departments that belong to some 

subgroup of interest; 

xi = response to a particular questionnaire item. Because most of the items on the 

Fire Department Survey are categorical, this will equal “1” if fire department i 

gives a particular response on a question and “0” otherwise. 

51 
FFFIPP Evaluation 

Table E.1. Fire Department Survey: Summary of Sample Weights 

Unequal 

Respondent Minimum Maximum Weighting 

Characteristic Sample Weight Weight Effect 

Total 1,622 1 61 1.458 

High-priority strata 

Total 262 1 6 1.255 

Strata 

Previous FFFIPP investigation involving 

a traumatic injury fatality 83 1 2 1.057 

Previous FFFIPP investigation involving 

a cardiovascular infarction fatality 58 1 2 1.023 

Traumatic injury fire fighter fatality 

without investigation 64 1 4 1.152 

Cardiovascular disease fire fighter 

fatality without investigation 57 2 6 1.074 

10 largest fire departmentsa

 0 — — — 

Remainder strata 

Total 1,360 1 61 1.264 

Census region 

Northeast 266 1 61 1.151 

South 433 2 41 1.297 

Midwest 453 1 41 1.203 

West 208 1 55 1.456 

Rural/urban 

Rural 823 1 32 1.072 

Urban 412 1 36 1.648 

Unknown 125 2 61 1.048 

Size (defined by population 

protected) 

Large (at least 50,000 persons) 211 1 9 1.183 

Medium (5,000-49,999 persons) 471 3 61 1.123 

Small (0-4,999 persons) 678 1 55 1.060 

Department type 

All career 271 1 21 1.389 

All volunteer 404 2 61 1.247 

Combination 685 1 39 1.025 

a Eight of the 10 largest fire departments are counted in the other high-priority strata. 

52 
FFFIPP Evaluation 

The estimates of means (e.g., percentages) were computed as 

∑ w x i i δ i

i∈Respondents . (E.2) ∑ w δi i

i∈Respondents 

Eligibility and Response Rates 

Ineligibility was determined using questions on the survey that specifically addressed 

the eligibility issues. The eligibility rate of those cases of unknown eligibility was assumed to 

be the same as those for which the eligibility was known. The cases of unknown eligibility 

were defined as fire departments from which we did not receive a response and that we 

were unable to contact to inquire about their eligibility. Known eligibility status was defined 

by the responses that we received from the survey and/or the information we received 

through ad hoc inquiries with the fire department about their eligibility. The eligibility rates 

were defined using the following formula: 

KE + e UK ( ) EligibilityRate = , (E.3) KE + KI + UK

where 

KE = known eligible. 

KI = known ineligible. 

UK = unknown eligibility, and 

KE

e = . KE + KI

The response rates for the survey were calculated based on the recommendations of 

the American Association for Public Opinion Research (AAPOR) published in its Standard 

Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys. As with the 

eligibility rate, this formula assumes that a proportion of the cases with unknown eligibility 

are eligible. The response rate was only calculated for those that were deemed either as 

known eligible or unknown eligibility. This being a mail survey, we did not have any 

“noncontacts.” The formula for the response rate was defined as follows: 

(I P+ ) RR4 = , (E.4) (I + P) + (R + NC + O) + e( UK)

53 
FFFIPP Evaluation 

where 

I = complete interview, 

P = partial interview, 

R = refusal, 

NC = noncontact, 

O = other nonresponse, 

UK = unknown eligibility, and 

KE

e = . KE + KI

Editing of Questionnaire Data 

All of the questionnaire data from responding fire departments have been edited to 

ensure every variable has a value for every record on the analysis file. This editing ensures 

a basic level of consistency between responses on each record when appropriate—for 

example, the data were edited to reflect the skip patterns present in the questionnaire. 

Variables resulting from questions that were skipped or intentionally missed were coded 

with a negative numeric value indicating the reason for item nonresponse. The following 

special codes were used: 

Code Definition 

−5 Bad Data 

−6 Multiple Response
 

−8 Blank (no answer) 

−9 Legitimate Skip
 

Estimation and Variance Estimation 

All estimates produced in the final analysis tables were generated with the final, 

nonresponse-adjusted sample weight. Variances were computed using RTI’s SUDAAN 

software to properly account for the complex design features of the study, such as 

stratification and unequal weighting. 

Unless otherwise noted, all estimates displayed in analysis tables were computed 

assuming that any item missing data was missing at random. Thus, percentages were 

computed only among the records that responded to the corresponding row item in the 

tables. 

54 
FFFIPP Evaluation 

Computing Confidence Intervals 

Asymmetric confidence intervals are displayed for all percentage estimates. These 

tend to have better coverage properties for percentage estimates, particularly for small 

percentages. These were computed as follows: 

Suppose f ( ) p = log( ) p − log(1 − p), where p is the percentage estimate. 

s( p) Then the standard error estimate of f ( p) is s[ f ( p)] ≈ . p(1− p) 

Suppose 

Lf = f ( p) − tα / 2 s[ f ( p)]
 

U f = f ( p) + tα / 2 s[ f ( p)] . 

Then the confidence interval for p will be 

⎛ exp(L ) exp( U ) ⎞ ⎜ f , f

⎟ . (E.5) ⎜1 + exp( L ) 1 + exp(U ) ⎟ ⎝ f f ⎠

Suppression Rule 

The suppression rule that was used for all tables is the following: 

If any estimate was less than 0.1 then a ** appears in the table and we included 

a footnote indicating “**Estimate rounds to zero.” 

⎛ s() θ ⎞ Any estimate with a relative standard error i e. ., that is greater than 0.50 or ⎜ ⎟ ⎝ θ ⎠

that has a sample size of 30 or less was considered imprecise. In the tables, we displayed a 

superscripted “+” and a footnote indicating “+Low precision” was displayed. Suppressed 

estimates were still displayed. 

Testing the Significance of Differences 

To test the significance of differences in the tables, we used the standard t-test as 

follows: 

θ1 −θ 2 Let T = , where s(θ −θ ) is the design-based standard error of the 

s(θ1 −θ 2 ) 1 2 

difference θ −θ . Then the significance probability associated with a two-sided test is equal 1 2 

to 

55 
FFFIPP Evaluation 

φ = 2 × ⎡

⎣

1 − P, (t < T )⎤

⎦ . (E.6) t df

If 0.00 ≤φ≤ 0.05, then the difference is deemed significant at the 95 percent 

confidence level. 

56 
FFFIPP Evaluation 

APPENDIX F. CHARACTERISTICS OF FOCUS GROUP 

PARTICIPANTS 

Number of Participants 34 

Career volunteer 

Career firefighters 16 

Volunteer firefighters 18 

Gender 

Male 29 

Female 5 

Urban/Rural 

Urban 5 

Suburban 14 

Rural 15 

Region 

Northeast 6 

South 22 

Midwest 6 

West 0 

Unionized 

Yes 15 

No 19 

57