Line-of-duty deaths among U.S. firefighters: An analysis of fatality investigations

▶ NIOSH investigations of LOD medical fatalities have consistently produced two recommendations for improvement: conduct regular pre-placement and annual medical screenings of firefighters, and make participation in wellness/fitness programs mandatory. ▶ Trauma or non-medical fatalities reveal a broader and more complex array of recommendations, but recommendations involving personnel management and planning/incident command account for about 70% of all high frequency recommendations in trauma cases. ▶ Further analysis of these recommendations reveal linkages to four higher order causal factors: under-resourcing, inadequate preparation/anticipation of adverse events during operations, incomplete adoption of incident command procedures, and sub-optimal personnel readiness. ▶ These deficiencies may be symptomatic of the fundamental cultural paradigm of firefighting. ▶ One that accepts and normalizes high levels of personal risk.