Death in the line of duty…A summary of a NIOSH fire fighter fatality investigation

On January 26, 2014, a 42-year-old male career fire fighter/EMT-B and a 31-year-old male career fire fighter/EMT-B died in a two-story attached garage apartment fire. Four engines, one truck, one rescue, and a battalion chief were initially dispatched to a structure fire with reported people inside the building. Battalion Chief 1 reported smoke showing from two blocks away. Engine 3 was first on-scene followed by Battalion Chief 1. Battalion Chief 1 assumed command and assigned Engine 3 who had parked in front of the building (Side Alpha) as Fire Attack. Engine 13 and Rescue 13 had arrived on-scene next and were assigned as Search and Back-up, respectively. Engine 6 arrived on scene and parked in the rear parking lot on Side Charlie. Engine 6 was assigned to Fire Attack on Side Charlie. Truck 17 arrived on scene, pulled past Engine 3, and was ordered to open up the roof. Engine 17 was assigned as the rapid intervention team (RIT). The incident commander was informed by an occupant that all occupants were out of the structure but a dog was on the second floor. Engine 3 made entry through a second-floor window and Engine 6 was at a second-floor doorway (on Side Delta). Both companies were advancing a 1¾-inch hoseline into the second-floor apartment. Battalion Chief 3 arrived on scene and reported heavy fire in the rear. Heavy, black smoke started coming out of the garage door and second-floor window on Side Alpha. Engine 3 transmitted a Mayday. Ten seconds later, the officer of Engine 3 came out the second-floor doorway onto the landing and called another Mayday. Engine 7 arrived on scene and was assigned to assist the RIT in locating the two fire fighters from Engine 3. Engine 7 reported heavy heat conditions in the second-floor apartment while trying to search. The Engine 17 RIT found one of the fire fighters from Engine 3 and removed him through the side door (Side Delta) and down the stairs to Life Squad 1for treatment. The Engine 17 RIT had to change air cylinders while Engine 19 and the safety officer (officer from Engine 19) continued the search for the other fire fighter. The Engine 17 RIT had just re-entered the structure when the second fire fighter was found. Both fire fighters were transported to the hospital but died from their injuries. Contributing Factors: 1. Arson

2. Risk assessment and Scene size-up

3. Resource deployment

4. Fireground tactics

5. Inadequate water supply

6. Crew staffing 7. No full-time safety officer

8. No sprinkler system in the building. Key Recommendations: 1. Fire departments should ensure that the incident commander conducts an initial 360-degree size-up and risk assessment of the incident scene to determine if interior fire-fighting operations are warranted. 2. Fire departments should integrate current fire behavior research findings developed by the National Institute of Standards and Technology (NIST) and Underwriter's Laboratories (UL) into operational procedures by developing standard operating procedures, conducting live fire training, and revising fireground tactics. 3. Fire departments should ensure all fireground ventilation is coordinated with fire-fighting operations. 4. Fire departments should ensure that the incident commander establishes a stationary command post for effective incident management, which includes the use of a tactical worksheet, efficient fireground communications, and a personnel accountability system. 5. Fire departments should ensure that all companies are staffed with an officer on the fireground. 6. Fire departments should ensure that the incident commander assigns a safety officer as early in the incident as possible as defined by NPFA 1561 Standard on Emergency Services Organization Incident Management System and Command Safety.