Reducing Injuries: Putting the Effort Where It Counts

Reducing Injuries: Putting the Effort Where it Counts
(Billy Adkins photo)

As a service, we have claimed to use risk management techniques to make safer fire departments.  How do we know that we’re focused in the right places?  Sometimes, we’re using risk management principles, even though we may forget that we are.  Are you training your firefighters to National Fire Protection Association (NFPA) standards?  There, you just practiced risk management.  Those standards have been established to reduce risks and prevent accidents from reoccurring.  Are your fire trucks purchased to meet NFPA standards at the time of purchase?  Same thing, years of accident data form risks, and standards are created to mitigate them.

Recently, a cross-functional team of researchers including health professionals, academics, and fire service personnel published a formal academic report focused on using risk-based approaches to reduce firefighter injuries.1 We all know that firefighting is dangerous, and our well-known line-of-duty death (LODD) statistics support that knowledge.  In 2016, 89 firefighters died while on-duty, and more than 62,085 were injured, according to the NFPA.2,3

In industrial safety conversations across multiple industries outside of the fire service, proactive risk management has been embraced as a strategy to reduce injuries and implement strategies to control risks.  By influencing the surrounding work environment, work conditions, equipment, personnel, and other factors, proactive risk management pulls the workers into the risk identification process and gives them an ability to place controls to make improvements.

It's interesting to note that in the fire service in the United Kingdom, proactive risk management is regulated as a requirement.  Even though this is not presently the case in the U.S. fire service, and proactive risk management is not mandated by legislation, there is the potential for benefits to U.S. fire departments from even voluntary approaches to proactive risk management.

In the most recent study, a large metropolitan fire department partnered with researchers to implement a proactive risk management approach for health and safety in the department.  Through the process 45 hazard-specific interventions were identified, and eight were implemented in the department over a two-year period.  The interventions focused on three specific tasks: physical exercise, patient transport, and fireground activities and operations.  When the researchers reviewed data for six years prior to their intervention, these three tasks accounted for a significant proportion of injuries.

To improve the area of physical exercise, equipment was updated and equipment that didn’t meet department standards was removed.  Equipment was also inspected monthly for maintenance, and the role of peer fitness trainers was expanded.  The standard operating procedure (SOP) for physical fitness was updated and included mobility exercises instead of static ones.  In patient transport, a slide board and a carry strap for patient lift assists were implemented to reduce strain injuries.  Also, ambulances were equipped with electronic gurneys as a part of a related effort.  Instruction was provided for probationary firefighters and medics on how to operate this new equipment.  Finally, changes in cardiopulmonary resuscitation (CPR) were implemented, as CPR was viewed as a fatiguing task.  The new procedure included rotating CPR responsibility every 200 compressions, or two minutes, when personnel are available.

To improve controls on the fireground, a focus on personal protective equipment (PPE) was taken.  The safety officer was empowered to remove firefighters from a scene if proper PPE was not worn.  The rehab sector paramedic was also empowered, and the SOP for rehab was updated to position rehab farther away from on-scene activities to separate firefighters from exposure to the tactical operations.  Additional paramedics are added to the rehab sector for multiple-alarm responses, and active cooling using 15-minute forearm immersion in cold water for heat-stressed personnel was added.

As a way of enforcing the implemented mitigation strategies, visual reminders in the form of posters, placards, and signage were implemented in the department.  As an example, a urine hydration chart was posted in all fire station bathrooms to promote hydration awareness.  Another visual reminder to use three points of contact when entering or exiting apparatus was placed on the inside of all apparatus doors to help reduce joint injuries.  Efforts across all these control strategies were discussed with the firefighters during morning roll call, on a project Web site, at the department safety committee meetings, and in station visits by chiefs.

In the beginning of the study, nearly 59% of the firefighters didn’t use the patient transfer devices, even though almost 88% of the firefighters thought that they would improve safety.  As the study progressed into the second year, nearly 71% of the firefighters had received instructions on how to use the devices (a 20% increase), and 34% stated that they preferred using a speedsheet over the slide board.  The speedsheet is disposable and reduces the force required for patient transfer.

The hydration charts made a big difference, as 68% of firefighters reported hydration symptoms on duty; 95% of fire personnel reported that they noticed the hydration chart in their station and learned about hydration from the internal department newsletter, 62% of firefighters reported that their awareness of hydration improved, and 43% stated that their actual hydration improved since the charts were posted. Furthermore, 90% of the firefighters noticed the “Save your joints, use 3-points” signs on the inside of apparatus doors, and 44% of firefighters said that they became more aware of how they enter and exit apparatus as a result.

In the rehab area, 84% of medics reported that the updated rehab report form, adopting national standards for rehab (NFPA 1584), was an efficient way to help rehab firefighters.  They liked that they could show the firefighters the protocols and data about their vitals before they return to the fireground.  86% of medics also felt that it was useful to have the rehab site criteria in front of them when setting up the rehab area when they needed one.  About half of the firefighters reported that the rehab area was not different from their prior experiences, but a majority of those firefighters had not been in rehab for a while or since the changes took place, suggesting that this may be an area where changes are not as visible to the firefighters, even though they could result in significant risk mitigation.

Overall, this study provides some new findings to the U.S. fire service on the effectiveness of proactive risk management control strategies.  As fire departments review these results, it is important to note that there is a significant gap in research around implementation of interventions.  As fire departments determine their own areas of risk and implement their own control strategies, a key success factor will be the effectiveness of training in safety and health and the knowledge of firefighters about interventions to help them adopt changes in behaviors.

As a practice, risk management approaches are perfect for engagement of firefighters, because these methods allow the firefighters themselves to identify key risks and become a part of their own solutions.  By mapping risks to controls, and implementing interventions, it is possible to systematically reduce injuries.  Fire departments that are interested in using a proactive risk management strategy should review ways to fully integrate the approach to make firefighters aware of the intent of such efforts.  Aside from internal department meetings and newsletters, safety committees, safety officers, and new personnel can become ambassadors of safety and assist in communication efforts.  Departments can also learn from their own progress and develop continuing education training that considers local, individualized examples of risk reduction from inside the department itself.



1.      Pollack, K.M., Poplin, G.S., Griffin, S., Peate, W., Nash, V., Nied, E., Gulotta, J., Burgess, J.  (2016).  Implementing Risk Management to Reduce Injuries in the U.S. Fire Service.  Journal of Safety Research.

2.      United States Fire Administration (USFA) (2017).  Firefighter Fatalities in the United States in 2016.  Federal Emergency Management Agency (FEMA).

3.      Haynes, J.G. & Molis, J.L. (2017).  Firefighter Injuries in the United States.  National Fire Protection Association Research.


DR. NATHANIEL J. MELBY is a 20-year veteran of the fire service and chief for the Campbell (WI) Fire Department. He serves on the Board of Directors of the Wisconsin State Fire Chiefs Association and is the president of the La Crosse County Fire Officers Association. Melby is a recipient of the Chief Fire Officer designation from the Center for Public Safety Excellence and the member grade designation from the Institution of Fire Engineers. A Wisconsin Technical College System Fire Service training state representative and a fire instructor for Western Technical College, he has developed and taught graduate and undergraduate courses in management and technology at multiple universities and has a full-time career in the energy industry as a technology executive. Melby has a bachelor’s degree from the University of Wisconsin-La Crosse, an M.B.A. from the University of Wisconsin-Whitewater, and a Ph.D. from Nova Southeastern University. 



Clarion UX