William Mora
Captain, San Antonio (TX) Fire Department

As a guide to prevent Firefighter Line-of-Duty-Deaths sixteen Firefighter Life Safety Initiatives were developed at a Firefighter Life Safety Summit in the spring of 2004. These initiatives targeted six major categories including: Structural Firefighting, Wildland Firefighting, Training and Research, Vehicle Operations, Health-Wellness-Fitness, and Reduction of Emergency Incidents and Risks. The ultimate goal of the initiatives however, is their implementation, so that injuries and fatalities can in fact be prevented in each category. Reaching this goal for the Structural Firefighting category in part, will require learning the real causes of fatalities and carefully modifying strategy, tactics, and tasks to increase safety on the fireground. Simply put: making corrective changes to save firefighters' lives. Firefighter fatalities in structure fires is an engrained occupational curse of the American fire service. The losses have been devastating and are, unfortunately, continual. According to the 2005 National Fire Service Research Agenda Symposium, "Each year, over a period of 15 years, an average of 11 firefighters has died from asphyxiation or burns while performing interior structural firefighting operations. Many of these fatalities occur in scenarios that involve factors of disorientation, physical exhaustion, running out of air and /or being overcome by rapidly changing conditions while operating within a dangerous environment."

Why Is This Happening?

When a structural line-of-duty death is reported, it is easy to assume that those involved made a tactical error, or that their equipment malfunctioned or that something else out of the ordinary must have occurred. Some concerns that typically arise with an announcement of a fatality include:

• Were SOPs followed?
• Was the Incident Command System in place?
• Was adequate staffing on hand?
• Were firefighters properly equipped and trained?
• Was a Rapid Intervention Team in place?
• Was there accountability? or
• Was the Risk vs. Gain considered?

On many occasions, these fireground concerns were ultimately determined to be contributing factors to unfavorable outcomes. But despite preventive recommendations offered, similar fatalities continue to occur. Adding to the complexity of the dilemma, structural fatalities also remain consistently high even in light of significant advances in personal protective equipment and greater utilization of firefighting safety technology.

In an effort to understand these fatalities, one observation was made: In several of the traumatic structural firefighter fatality cases investigated and reported through the years, firefighters who lost their lives conducting interior attacks did precisely what they were trained, ordered, or expected to do. With complete confidence, firefighters implemented widely accepted strategy and tactics which had always worked for them throughout their careers. The fallen firefighters assumed command, sized up the situation, advanced an attack line from the unburned side, searched for the seat of the fire and conducted a primary search. In short, the firefighters fought the fire aggressively and by the book, and in spite of this, some were unable to exit the building and died. So, why is this happening?

The 3rd and 4th Life Safety Initiatives developed are applicable to structural firefighting. The 3rd initiative specifically urges firefighters to "focus greater attention on the integration of risk management with incident management at all levels, including strategic, tactical, and planning responsibilities." While the 4th initiative states "Empower all firefighters to stop unsafe practices." Although both of these initiatives can be effective when attempting to manage the risks and unsafe practices that are commonly known in the fire service, the monumental problem however, lies with the unsafe practices and risks that are widely unknown and that are doing most of the physical, emotional, and structural damage. In other words, to be truly effective at integrating risk management with incident management and truly effective at stopping all unsafe practices on the fireground, firefighters must be aware of the unknown risks and must be able to identify them instinctively at the beginning and during the course of operations. Any shortcomings in this area will eventually mean repetition of tragic outcomes on the fireground. While acknowledged that some causes of structural firefighter fatalities are indeed difficult to anticipate; many are now known and predictable.

Major Contributing Factors

Years of structural firefighter fatality case analysis has shown that there are five underlying factors contributing to certain firefighter fatalities. Because these factors have essentially been unknown in the fire service, they provide one reasonable explanation why so many dedicated, experienced and courageous firefighters may have unexpectedly died in the line of duty in the past and why it continues today. These contributing factors include:

1. Firefighters are not universally cognizant that enclosed structures are repeatedly injuring and claiming the lives of firefighters.
2. Firefighters are unknowingly, yet seriously, misinterpreting initial size-up factors.
3. Firefighters are not aware that a "fast and aggressive interior attack" is not consistently safe or effective enough to be used at enclosed structure fires.
4. Firefighters are not aware that traditional tactics and tasks are not consistently safe or effective enough to be used at enclosed structure fires.
5. Firefighters are not aware of the "firefighter disorientation sequence" that often leads to serious injuries and fatalities.

One guarantee can unfortunately be made: If firefighters do not become familiar with and do not operationally adjust to these factors, the high rate of serious injuries and fatalities nationally will remain constant. Furthermore, because virtually all departments are using the same traditional strategy and tactics, almost every active firefighter is at risk. When conditions are right, the fatalities are resulting from injuries following exposure to flashover, backdraft, prolonged zero visibility conditions; collapse of floors and roofs; and firefighter disorientation. However, it can all be prevented. By knowing which structures a fatality is most likely to occur, half the battle is won. This is true whether you are a member of a volunteer or combination department or a full-time firefighter serving in a metro department. After identifying the structure, all that remains is to utilize tactics which will prevent exposure to the hazards.

Enclosed Structures and Their Dangers

An enclosed structure is an unprotected structure in which there is an absence of windows or doors of sufficient number and size to provide prompt ventilation and emergency evacuation. According to findings of the U.S. Firefighter Disorientation Study 1979-2001, Enclosed Structures are highly prone to producing life-threatening hazards and are directly linked to firefighter disorientation and line-of-duty deaths. One encouraging fact, however, is that in the vast majority of cases, enclosed structures are distinguishable. These types of structures, which exist in tremendous numbers and in every community of the nation, can be of any size, age, or type of construction. They can also be occupied, unoccupied, or vacant during a fire. They may include virtually any type of occupancy, such as a single-family dwelling, a warehouse, an auto shop, a church, a restaurant, a row house, or a grocery store. They also include structures with basements and the hallways of high-rise buildings. A structure's occupancy type has traditionally been a major indicator of the possible risk that can be encountered during a fire. However, in addition to all previously known structural risks and for safety, firefighters must now be intensely and primarily aware of the severe hazards associated with unprotected enclosed structures. If a structure is enclosed and not protected by an operable sprinkler system, its overall degree of risk during a fire is significantly greater and it must therefore be considered extremely dangerous when encountered. An enclosed structure will retain and conceal the heat and smoke generated during a fire to expose unsuspecting firefighters to life-threatening hazards during an aggressive interior attack or as firefighters attempt an emergency evacuation. Enclosed structure fires are not to be mistaken for those structure fires safely handled on a daily basis. Rather, enclosed structures should be considered extremely dangerous because of their dismal record of repeatedly causing serious injuries and firefighter fatalities. Training and dedicated strategy and tactics are clearly needed to break the continuous chain of enclosed structure fatalities.

Enclosed Structure Tactics and Guidelines

Distinct tactics for enclosed structure fires, as well as flexible standard operating guidelines for them, must be considered to prevent line-of-duty deaths in these buildings. Based on lessons learned from previous enclosed structure fires, these tactics must be more cautious and calculated in every phase of the operation, including when searching for the seat of the fire, when approaching the seat of the fire, or when conducting a primary search. In addition to other precautions and approaches, SOGs for enclosed structures must be completely understood by all members. The SOGs should incorporate the use of an initial assessment team equipped with a charged handline and a thermal imaging camera. This team is supported by a backup company equipped with charged backup handline, thermal imaging camera, and charged supply line. A rapid intervention team is also standing by at the point of entry. Thermal imaging cameras are used to assist firefighters during a cautious interior assessment. Used in place of the traditional fast, aggressive interior attack, a cautious interior assessment manages the risk by the visibility provided by a thermal imaging camera to determine if:

1. an interior attack can be safely initiated from the original entry point;
2. a defensive exterior attack should be made;
3. a short interior attack should be implemented.

A short interior attack is an enclosed structure tactic whereby interior attack is initiated after the distance from the exterior to the seat of the fire is minimized to achieve greater safety. This involves forcibly opening pre-existing enclosed windows or doors or aggressive breaching of exterior or interior adjoining walls, close to the seat of the fire, to provide easier and safer access for firefighters.

Tactics for Enclosed Structures with Basements

Structures with basements are safely managed by firefighters every day. And this occurs when firefighters are aware that the structure has a basement and when they know that the first floor assembly is absolutely not being weakened by the fire. Additional tactics are needed for enclosed structures with basements. The first-arriving company must determine if the structure has a basement and, if so, if it is involved in fire. A 360-degree walk around the structure should be performed prior to advancing into the structure. When fire is showing from basement windows or doors, all responding firefighters must be immediately warned via radio not to enter the structure and consider using exterior straight stream attacks to immediately and aggressively knock down the main body of fire. Firefighters should also remain in those positions to prevent flare ups prior to walking onto the first floor. Should the first floor collapse as firefighters subsequently conduct a primary search or check for extension, firefighters do not fall into an active basement fire and survival is enhanced. By initially attacking visible fire showing from the basement, vertical extension of fire which may have potentially trapped firefighters who entered the structure may be prevented. In addition and when needed, vigorous but safe breaching of a floor with chain saws can be initiated on arrival to expose and immediately attack a fire from the exterior at any structure with a basement. This tactic may also prevent firefighter exposure to flashover, backdraft, prolonged zero visibility conditions, firefighter disorientation, or from becoming trapped by a collapse of the first floor. In addition, because knockdown from the exterior has been accomplished prior to advancing into the basement, survival is enhanced should a firefighter become entangled or trapped by contents or debris encountered in the basement.

These are some enclosed structure tactics, based on lessons learned, which can be considered for the professional management of enclosed structure fires. Although some structural firefighter fatalities are difficult to predict, this is no longer true in the case of enclosed structures. Through the development of enclosed structure tactics, flexible enclosed structure SOGs, and appropriate training, future cases of firefighter disorientation and line-of-duty deaths can be prevented. In the final analysis, all we have to do is change the way we fight fire. So, what do we have to lose?

Note: In addition to major structural and operational findings, the U.S. Firefighter Disorientation Study found a direct link between Enclosed Structures, Firefighter Disorientation and Firefighter Fatalities.

For more information:

1. Mora, W.R., "U.S. Firefighter Disorientation Study, 1979-2001" (2003).
2. Mora, W.R., "No More Maydays", Fire Chief, vol. 47, August 2003, 100-109.
3. Mora, W.R., "Understanding and Solving Firefighter Disorientation", Fire Engineering, vol. 158, June 2005, 103-114.
4. Mora, W.R., "Enclosed Structure Disorientation", Firehouse.com, January 2006
5. capmora@aol.com