I was surprised and angry at Sunday social media posts by Bill Carey that made an assertion that a statement in the 3rd edition of Fire Officer: Principles and Practice (2015) is a lie. While I provided a response to Bill on his FaceBook post and tweet, I need more space to completely describe the issue and respond to the questions that the “What a Lie” post generated.

Origin and Timeline of “Chapter 16: Rules of Engagement”

“Chapter 16: Rules of Engagement” was a special feature of the third edition. The International Association of Fire Chiefs (IAFC) asked for a dedicated chapter on this topic.  Chief Gary Morris was the director at large on the IAFC Safety, Health & Survival Section’s board of directors and the team lead for the Rules of Engagement (ROE) project. This project was a major initiative by the IAFC in 2012-2013. Chief Morris provided a 251-page draft as the source document for Chapter 16. I was honored to work with Gary – years earlier he sent me a copy of his master’s thesis as assistance on a fire department project.

The first draft of the chapter was sent to Jones and Bartlett Learning (JBL) on June 28, 2013. That draft was shared with some of the 56 fire service reviewers engaged by JBL in the Fire Officer project. It was also reviewed by NFPA and IAFC representatives, the co-publishers of the textbook. The editorial team took that feedback, along with their comments, and sent the chapter back to me.

A revised chapter, reflecting the feedback, was sent back to the editors on October 3, 2013.  Once the chapter is completely formatted there is another review – think dress rehearsal. The dress rehearsal review of Chapter 16 was done on October 30, 2013.

“Fire fighters are much more likely to die in fires than civilians are”

This screenshot was part of Carey’s social media post. It came from page 334 of the textbook.

The circled statement is inaccurate based on our firefighter fatality experience since 2014.

So where did this statement come from? You can find the two sources on page 319.

Part of the information came from a June 2007 retrospective report written by the Fire Analysis and Research Division and published by the National Fire Protection Association:

Fahy., R. F., LeBlanc, P. R. and Molis, J. L. (2007) What’s Changed Over the Past 30 Years?

2007 marked the 30th year that NFPA has made an effort to identify all on-duty firefighter fatalities on an annual basis.  The Fire Analysis and Research Division identified a trend showing an increase of firefighter death rate within structure fires while the number of structure fires declined.

The second source was a 2009 Executive Fire Officer research report by Captain Stephen Marsar “Can They Be Saved? Utilizing Civilian Survivability Profiling to Enhance Size-up and Reduce Firefighter Fatalities in the Fire Department, City of New York.”

There were many trade journal articles describing survivability profiling. We used the November 2011 article from Fire Rescue Magazine to get this graphic – which is where that summary statement came from. The summary statement “Fire fighters are much more likely to die in fires than civilians are” was referring to structure fires where civilians were killed in the same building as firefighters.

This part of Chapter 16 is titled “Fire Fighter Survivability inside Structure Fires.” It is the opening segment of the IAFC Rules of Engagement for Structural Firefighting program and was designed as a motivator for the chief or company officer learning about ROE.

Other references that were used in this chapter are listed on pages 335 and 336.  The newest NFPA fatality report available covered the 2012 fatalities. We also used Baldwin’s November 2008 NIOSH Leading Recommendations for Preventing Firefighter Fatalities, 1998-2005. The IAFC 2012 Rules of Engagement for Structural Firefighting included details on 10 NIOSH LODD investigations covering incidents from 2000 to 2010.

At the time of publication, we were using LODD information from multiple sources and presented the information as we understood it. This information was reviewed by fellow fire service members, as well as NFPA and IAFC representatives. It was accurate at the time of publication.

I disagree with Bill Carey’s statement that there was a lie printed on page 334 of the textbook.

As Bill Carey documents, we are experiencing a dramatic change in our firefighter fatality experience that started in 2014. Unfortunately, I lacked that clairvoyance when writing Chapter 16 in 2013.

LODD coverage in the Fourth Edition

The fourth edition of the textbook is coming out to support the 2020 version of NFPA 1021. The information on firefighter LODDs will reflect the dramatic changes in our experiences between 2014 and 2018. You can get a preview of that narrative by reading How are we doing with “Everybody Goes Home”? Great strides but new challenges. 

Is Suicide, Occupational Cancer or Sudden Cardiac Arrest the Cause of Most Firefighter Deaths?

In the “Firefighter Fatalities in the US – 2018” Fahy and Molis added a section on long-term effects on firefighters’ physical and emotional health. They covered suicide, cancer, and cardiac issues. The 2020 version of NFPA Standard 1021 added “behavioral health issues” and “suicide prevention initiatives” to the requisite knowledge requirements. The editor for the Fourth Edition wanted clarity on what cause was responsible for most of the firefighter deaths.

Suicide

Since 2017, the rate of firefighter suicide exceeds the rate of line-of-duty deaths (Heyman, Dill & Douglas 2018). A 2015 study by Firefighter Behavioral Health Alliance (FFBHA) reports that 37% of those surveyed contemplated suicide and almost 7% had attempted it. That is more than 10 times the rate of the general population (Fisher, 2018).

The fire service has not established a national system to record and report on firefighter suicides. We are a bit like NFPA was in 1976 when they decided to make an effort to record all line-of-duty firefighter deaths. We will have more information by time we are working on the Fifth Edition of the textbook.

Occupational Cancer

The International Association of Fire Fighters reports that nearly 60 percent of the names added to IAFF Fallen Fire Fighter Memorial since 2002 are those of firefighters who have died from occupational cancers. (IAFF 2018 and 2015)

A total of 33 states cover firefighters for one or more cancers under workers’ compensation as a result of presumption legislation. In 20 of these states, the language in the presumption legislation contains broad or nonspecific language that can be interpreted to cover any cancer experienced by a firefighter. In the other 13 states, only certain specific cancers are covered, most commonly leukemia (12 states), brain cancer (10 states), bladder cancer (9 states), non-Hodgkin lymphoma (9 states), and gastrointestinal cancer (8 states). (FRCE 2019)

This summer I wrote about the organizational resistance Texas was demonstrating towards firefighters requesting worker compensation for cancer diagnosis.

Earlier this year, the National Institute for Occupational Safety and Health (NIOSH) requested input about three possible enrollment strategies. Specifically, NIOSH is asking for input on how to maximize participation for the Registry.

The “National Firefighter Registry” will allow CDC/NIOSH will collect work history and exposure records to explore the relationship between exposures and cancer. They will also link with state cancer registries to confirm diagnoses. Findings will be shared through scientific publications and communications to stakeholders and the public.

Results of the National Firefighter Registry may guide our discussion on firefighter deaths when we are working on the Fifth Edition of the textbook in 2024.

Sudden Cardiac Arrest

We are still dropping dead of sudden cardiac arrest, the #1 cause of line-of-duty deaths since NFPA began tracking trends in 1977.

For 2018 it represents 39% of the LODD deaths. It remains the one metric identified in the 2004 Firefighter Life Safety Summit that has not been reduced.

IAFC President Gary Ludwig is making this his initiative, will be rolling out “If You Don’t Feel Well – Don’t Make It Your Farewell” campaign in 2020.

We stayed with sudden cardiac arrest as the leading cause of firefighter deaths. It is tracked by all of the reporting systems, it is part of the federal LODD coverage and we have data going back to 1977.

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2019 October 7: How are we doing with “Everybody Goes Home”? Great strides but new challenges.  CompanyCommander.com

Fahy, R. F. and J. L. Molis (2019 June). Firefighter Fatalities in the US – 2018. Quincy MA, National Fire Protection Association.  https://www.nfpa.org/-/media/Files/News-and-Research/Fire-statistics-and-reports/Emergency-responders/osFFF.pdf

Hayman, M., J. Dill and R. Douglas (2018). The Ruderman White Paper on Mental Health and Suicide of First Responders. Boston, Ruderman Family Foundation.

Fisher, N. (2018). More Firefighters Committed Suicide In 2017 Than Died In Line Of Duty. Forbes. New York, Forbes.

IAFF (2018 February 01) Cancer Summit.  http://client.prod.iaff.org/#page=Cancer_Summit_2018

IAFF (2015) Cancer In The Fire Service. John P. Redmond Symposium. National Harbor, MD.   https://services.prod.iaff.org/ContentFile/Get/10166

First Responder Center For Excellence [FRCE} (2019) Presumptive Legislation for Firefighter Cancer. Crofton, MD: First Responder Center for Excellence for Reducing Occupational Illness, Injuries and Deaths, Inc.  https://www.firstrespondercenter.org/cancer/toolsresources/presumptive-legislation-firefighter-cancer-state/

2019 July 22: Texas Firefighter Cancer Presumption – An Exhausting Example of Organizational Resistance

Gabbert, Bill (2019 March 27) “Establishment of firefighter cancer registry is progressing:
The next step is to collect input from firefighters and stakeholders on an approach to the Registry including potential enrollment methods” Wildfire Today  https://wildfiretoday.com/2019/03/27/establishment-of-firefighter-cancer-registry-is-progressing/