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

More than 100 firefighters die in the line-of-duty in the U.S. each year and over 80,000 are injured. This study examined all firefighter fatality investigations (N = 189) completed by the National Institute for Occupational Safety and Health (NIOSH) for fatalities occurring between 2004 and 2009. These investigations produced a total of 1167 recommendations for corrective actions. Thirty-five high frequency recommendations were derived from the total set: six related to medical fatalities and 29 to injury-related fatalities. These high frequency recommendations were mapped onto the major operational components of firefighting using a fishbone or cause-effect diagram. Over 70% of the 30 non-external recommendations were categorized within the personnel and incident command components of the fishbone diagram. Root cause techniques suggested four higher order causes: under-resourcing, inadequate preparation for/anticipation of adverse events during operations, incomplete adoption of incident command procedures, and sub-optimal personnel readiness. These findings are discussed with respect to the core culture of firefighting.